Provider Demographics
NPI:1851640528
Name:BRISBON, DELLA TERESA
Entity type:Individual
Prefix:MS
First Name:DELLA
Middle Name:TERESA
Last Name:BRISBON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 BALSAM RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-7917
Mailing Address - Country:US
Mailing Address - Phone:803-561-9057
Mailing Address - Fax:803-561-9057
Practice Address - Street 1:2708 NE 14TH ST
Practice Address - Street 2:SUITE 5,
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-3565
Practice Address - Country:US
Practice Address - Phone:888-880-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist