Provider Demographics
NPI:1811610348
Name:MILLETTE, BRIAN J
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:J
Last Name:MILLETTE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 MONTEREY OAKS BLVD APT 425
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1087
Mailing Address - Country:US
Mailing Address - Phone:708-296-7687
Mailing Address - Fax:
Practice Address - Street 1:5388 DISCOVERY PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-8218
Practice Address - Country:US
Practice Address - Phone:757-903-4230
Practice Address - Fax:757-903-4231
Is Sole Proprietor?:No
Enumeration Date:2022-09-20
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACP034875T225100000X
TX1367965225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist