Provider Demographics
NPI:1992484109
Name:BRASCIA, JEFF (DPT)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:BRASCIA
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 1:4233 BETH PL
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91214-2406
Mailing Address - Country:US
Mailing Address - Phone:818-813-3673
Mailing Address - Fax:
Practice Address - Street 1:2212 EL MOLINO AVE
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-3000
Practice Address - Country:US
Practice Address - Phone:877-369-6650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36509208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation