Healthcare Provider Details

I. General information

NPI: 1164523205
Provider Name (Legal Business Name): JULIE KAY BREINING PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 10/27/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3491 LINCOLN RD
HAMILTON MI
49419-9512
US

IV. Provider business mailing address

3491 LINCOLN RD
HAMILTON MI
49419-9533
US

V. Phone/Fax

Practice location:
  • Phone: 269-751-2150
  • Fax:
Mailing address:
  • Phone: 269-751-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number5501011224
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: