Provider Demographics
NPI:1780093252
Name:BRUSHABER, EMILY
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BRUSHABER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1822
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48346
Mailing Address - Country:US
Mailing Address - Phone:248-622-7990
Mailing Address - Fax:
Practice Address - Street 1:5405 LANCASTER HILLS DR
Practice Address - Street 2:42
Practice Address - City:CLARKSTON
Practice Address - State:MI
Practice Address - Zip Code:48346-4426
Practice Address - Country:US
Practice Address - Phone:248-622-7990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004861A225200000X
MI5502002630225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant