Healthcare Provider Details

I. General information

NPI: 1942494224
Provider Name (Legal Business Name): ROBERT P BRETON CO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 BARRETT LN
UNDERHILL VT
05489
US

IV. Provider business mailing address

13 BARRETT LN
UNDERHILL VT
05489
US

V. Phone/Fax

Practice location:
  • Phone: 802-324-3691
  • Fax:
Mailing address:
  • Phone: 802-324-3691
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number003643
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: