Healthcare Provider Details

I. General information

NPI: 1740246537
Provider Name (Legal Business Name): JONI MARIE BREAUX LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 COUNTRY CLUB RD SUITE 150
EUGENE OR
97401
US

IV. Provider business mailing address

88899 KNIGHT ROAD
VENETA OR
97487
US

V. Phone/Fax

Practice location:
  • Phone: 541-683-5139
  • Fax: 541-683-5783
Mailing address:
  • Phone: 541-935-2068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number7394
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: