Healthcare Provider Details

I. General information

NPI: 1407822901
Provider Name (Legal Business Name): ALLEN C. BREINDEL PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 04/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 MARKET ST SUITE A
WARREN PA
16365-4682
US

IV. Provider business mailing address

2265 MARKET ST SUITE A
WARREN PA
16365-4682
US

V. Phone/Fax

Practice location:
  • Phone: 814-726-9050
  • Fax: 814-726-9629
Mailing address:
  • Phone: 814-726-9050
  • Fax: 814-726-9629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT004083L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberDAPT000360
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: