Provider Demographics
NPI:1811455033
Name:BROWNLEE, DESTINIE MARIE
Entity type:Individual
Prefix:
First Name:DESTINIE
Middle Name:MARIE
Last Name:BROWNLEE
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 1:2604 BERKLEY ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-2830
Mailing Address - Country:US
Mailing Address - Phone:202-425-4108
Mailing Address - Fax:
Practice Address - Street 1:2604 BERKLEY ST
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-2830
Practice Address - Country:US
Practice Address - Phone:202-425-4108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer