Healthcare Provider Details

I. General information

NPI: 1952707614
Provider Name (Legal Business Name): KEVIN BREEN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 11/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 WAYNE AVE STE 308 119 PROFESSIONAL BUILDING
INDIANA PA
15701-3501
US

IV. Provider business mailing address

1265 WAYNE AVE STE 308 119 PROFESSIONAL BUILDING
INDIANA PA
15701-3501
US

V. Phone/Fax

Practice location:
  • Phone: 724-801-8095
  • Fax: 724-801-8147
Mailing address:
  • Phone: 724-801-8095
  • Fax: 724-801-8147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT023854
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: