Healthcare Provider Details

I. General information

NPI: 1447962741
Provider Name (Legal Business Name): SAMARA LILY BREUER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6649 UNIVERSITY AVE STE 100
MIDDLETON WI
53562-3021
US

IV. Provider business mailing address

6649 UNIVERSITY AVE STE 100
MIDDLETON WI
53562-3021
US

V. Phone/Fax

Practice location:
  • Phone: 608-841-1290
  • Fax: 608-841-1299
Mailing address:
  • Phone: 608-841-1290
  • Fax: 608-841-1299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number17701-24
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: