Provider Demographics
NPI:1710719653
Name:DEBARROS, BREANNE (PT, DPT)
Entity type:Individual
Prefix:
First Name:BREANNE
Middle Name:
Last Name:DEBARROS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-6243
Mailing Address - Country:US
Mailing Address - Phone:518-203-6761
Mailing Address - Fax:518-203-6762
Practice Address - Street 1:290 SPEIGLETOWN RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12182-1124
Practice Address - Country:US
Practice Address - Phone:518-279-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist