Provider Demographics
NPI:1770514036
Name:DELISLE, BRITTANY M (PT)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:M
Last Name:DELISLE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:M
Other - Last Name:LYON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2305 GENOA BUSINESS PARK DR STE 170
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-7005
Mailing Address - Country:US
Mailing Address - Phone:810-299-8557
Mailing Address - Fax:810-844-0837
Practice Address - Street 1:2305 GENOA BUSINESS PARK DR STE 170
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-7005
Practice Address - Country:US
Practice Address - Phone:810-299-8557
Practice Address - Fax:810-844-0837
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027524225100000X
MI5501019770225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY694693OtherACN PROVIDER ID NUMBER