Provider Demographics
NPI:1619853108
Name:LANOUETTE, BREANNA MARIA (PT, DPT, MS)
Entity type:Individual
Prefix:DR
First Name:BREANNA
Middle Name:MARIA
Last Name:LANOUETTE
Suffix:
Gender:F
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3489 FORESTDALE DR APT 2A
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8223
Mailing Address - Country:US
Mailing Address - Phone:407-417-3093
Mailing Address - Fax:
Practice Address - Street 1:505 BLAKELY HALL LN
Practice Address - Street 2:
Practice Address - City:ELON
Practice Address - State:NC
Practice Address - Zip Code:27244
Practice Address - Country:US
Practice Address - Phone:407-417-3093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP24273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist