Healthcare Provider Details

I. General information

NPI: 1821057068
Provider Name (Legal Business Name): BRETT A FIRING PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 N GALEN HALL RD APT. 9
WERNERSVILLE PA
19565-9333
US

IV. Provider business mailing address

217 N GALEN HALL RD APT. 9
WERNERSVILLE PA
19565-9333
US

V. Phone/Fax

Practice location:
  • Phone: 828-460-1421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberTE001430L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: