Donielle Lynn Brasure, MPT – Physical Therapist

Key facts

NPI: 1023100641
Entity type: Individual (NPI type 1)
Primary specialty: Physical Therapist 225100000X
License: J10001969 (DE)
Practice address: 232 Atlantic Ave
Millville, DE 19967-6728
Phone: (302) 539-3110
Fax: (302) 539-7237
NPI assigned: Sep 29, 2006
Sex: Female
Sole proprietor: No

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Aquaworx Physical Therapist · Berlin, MD · NPI 1912204983

Medicare reassignment Care Compare group NPD MD · PHYSICAL THERAPIST
Konlian,O'Neill & Associates, P.a. Rehabilitation Practitioner · Salisbury, MD · NPI 1083647515

Medicare reassignment NPD MD · PHYSICAL THERAPIST
Bayside Physical Therapy, L.L.C. Physical Therapist · Selbyville, DE · NPI 1912052309

NPD (past) PHYSICAL THERAPIST

Medicare Care Compare profile

Specialty: Physical Therapist in Private Practice
Education: Other, 2001
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: Aquaworx (8 clinicians)

Practice addresses (Care Compare)

11204 Racetrack Rd
Suite 101
Berlin, MD 21811-3370
Phone (410) 208-1525

Medicare participation

Medicare fee-for-service enrollment: Enrolled in MD

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20040206000610	MD	Practitioner - Physical Therapist in Private Practice	1658264197	Reassigns benefits to 2 organizations

National Provider Directory

Medicare enrollment (NPD): Yes

Practice roles

Organization	Specialty	Status	New patients
Konlian,O'Neill & Associates, P.a.	Physical Therapist	Current since Jan 1, 2014	Accepting new patients
Aquaworx	Physical Therapist	Current since Jun 1, 2019	Accepting new patients
Bayside Physical Therapy, L.L.C.	Physical Therapist	Past	Accepting new patients

Locations

11204 Racetrack Rd
Ste 101
Ocean Pines, MD 21811
Phone (410) 208-1525

106 Milford St
Ste 601
Salisbury, MD 21804
Phone (410) 548-7600

659 S Salisbury Blvd
Ste 1B
Salisbury, MD 21801
Phone (410) 831-3226

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Physical Therapist	225100000X	J10001969	DE	Yes

Addresses

Primary practice location

232 Atlantic Ave
Millville, DE 19967-6728

Mailing address

232 Atlantic Ave
Millville, DE 19967-6728
Phone (302) 539-3110

Other identifiers

Identifier	Type	State	Issuer
1023100641	Medicaid	DE

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 29, 2009.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248825600000",
    "number": "1023100641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "232 ATLANTIC AVE",
            "city": "MILLVILLE",
            "state": "DE",
            "postal_code": "199676728",
            "telephone_number": "302-539-3110",
            "fax_number": "302-539-7237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 ATLANTIC AVE",
            "city": "MILLVILLE",
            "state": "DE",
            "postal_code": "199676728",
            "telephone_number": "302-539-3110",
            "fax_number": "302-539-7237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRASURE",
        "first_name": "DONIELLE",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "MPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-29",
        "last_updated": "2009-07-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "DE",
            "license": "J10001969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023100641",
            "state": "DE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Millville, DE

All providers in Millville, DE · Physical Therapist in Delaware

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2009. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.