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General NPI Number Information
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NPI Number | 1003150624
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Entity Type | Individual
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Provider Name | KRISTINA ALICE BREESAWITZ PTA
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Gender | Female
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 1716 GIHON RD
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City | PARKERSBURG
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State | WV
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Zip | 26101-9655
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Country | US
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Telephone | 304-485-5511
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Fax |
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Provider Business Mailing Address
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Address Line | 2218 FAIRFAX ST
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City | PARKERSBURG
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State | WV
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Zip | 26101-6940
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Country | US
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Telephone | 304-481-0607
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 000621
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License Number State | WV
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