Healthcare Provider Details

I. General information

NPI: 1417649674
Provider Name (Legal Business Name): BREANNE ELYSE HUFFMAN PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 05/24/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 W OLENTANGY ST
POWELL OH
43065-8433
US

IV. Provider business mailing address

532 SALISBURY DR
POWELL OH
43065-8378
US

V. Phone/Fax

Practice location:
  • Phone: 614-460-9507
  • Fax:
Mailing address:
  • Phone: 614-519-3984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT020460
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: