Provider Demographics
NPI:1851666564
Name:DORENBUSH, BRITTANY LYNDE (PTA)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:LYNDE
Last Name:DORENBUSH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8480 LIMELIKN PIKE
Mailing Address - Street 2:APT 1025
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095-2801
Mailing Address - Country:US
Mailing Address - Phone:215-260-3130
Mailing Address - Fax:
Practice Address - Street 1:8480 LIMEKILN PIKE
Practice Address - Street 2:APT 1025
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-2801
Practice Address - Country:US
Practice Address - Phone:215-260-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-13
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATEI002659225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant