Healthcare Provider Details

I. General information

NPI: 1053308015
Provider Name (Legal Business Name): BREFELD PHYSICAL THERAPY SERVICES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 LINCOLN PLACE CT
BELLEVILLE IL
62221-5884
US

IV. Provider business mailing address

106 LINCOLN PLACE CT
BELLEVILLE IL
62221-5884
US

V. Phone/Fax

Practice location:
  • Phone: 618-236-7588
  • Fax: 618-236-7589
Mailing address:
  • Phone: 618-236-7588
  • Fax: 618-236-7589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL

VIII. Authorized Official

Name: JOAN L BREFELD
Title or Position: PRESIDENT
Credential: PT PCS
Phone: 618-236-7588