Provider Demographics
NPI:1952171282
Name:BRAINARD, DEBBY (PTA)
Entity Type:Individual
Prefix:
First Name:DEBBY
Middle Name:
Last Name:BRAINARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DEBBY
Other - Middle Name:
Other - Last Name:MORELLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:5845 CACTUS LN
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-9413
Mailing Address - Country:US
Mailing Address - Phone:319-123-4567
Mailing Address - Fax:
Practice Address - Street 1:1255 INDIANA STATE ROAD 46
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47803
Practice Address - Country:US
Practice Address - Phone:319-123-4567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant