Healthcare Provider Details

I. General information

NPI: 1003616889
Provider Name (Legal Business Name): BREANNA D. ALEWINE PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 W ROBERTSON ST STE 102
BRANDON FL
33511-4900
US

IV. Provider business mailing address

24917 NW 155TH AVE
HIGH SPRINGS FL
32643-6878
US

V. Phone/Fax

Practice location:
  • Phone: 813-978-9700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA33941
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: