Provider Demographics
NPI:1720351034
Name:DE BRUN, MILTON (DPT)
Entity type:Individual
Prefix:DR
First Name:MILTON
Middle Name:
Last Name:DE BRUN
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 1:5515 WARRENSBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37743-3282
Mailing Address - Country:US
Mailing Address - Phone:404-797-5058
Mailing Address - Fax:
Practice Address - Street 1:5515 WARRENSBURG RD
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-3282
Practice Address - Country:US
Practice Address - Phone:404-797-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26829225100000X
WV004564225100000X
TN14297225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist