Healthcare Provider Details

I. General information

NPI: 1922920131
Provider Name (Legal Business Name): RUBY LYNN BREUER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 US HIGHWAY 61
LANCASTER WI
53813-9306
US

IV. Provider business mailing address

3360 GATEWAY RD STE 100
BROOKFIELD WI
53045-5115
US

V. Phone/Fax

Practice location:
  • Phone: 608-723-2113
  • Fax:
Mailing address:
  • Phone: 262-923-7101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4359-19
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: