Provider Demographics
NPI:1194066415
Name:BRIGNONI, ELMER (DPT)
Entity type:Individual
Prefix:DR
First Name:ELMER
Middle Name:
Last Name:BRIGNONI
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 RIVIERA DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6741
Mailing Address - Country:US
Mailing Address - Phone:352-205-6147
Mailing Address - Fax:352-306-0571
Practice Address - Street 1:854 S DUNCAN DR
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4044
Practice Address - Country:US
Practice Address - Phone:352-205-6147
Practice Address - Fax:352-306-0571
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-12
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT27229261QP2000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy