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General NPI Number Information
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NPI Number | 1013290915
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Entity Type | Individual
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Provider Name | LISA MICHELE BRETON PTA, LAC
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Gender | Female
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Dates
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Enumeration Date | 09/27/2011
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Last Update Date | 12/07/2023
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Provider Practice Location Address
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Address Line | 35 BUNKER HILL RD
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City | WATERTOWN
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State | CT
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Zip | 06795-3304
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Country | US
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Telephone | 860-274-5429
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Fax |
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Provider Business Mailing Address
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Address Line | 117 RIVER ST UNIT B
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City | MILFORD
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State | CT
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Zip | 06460-3315
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Country | US
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Telephone | 203-442-6297
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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 | 000064
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 000860
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License Number State | CT
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