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General NPI Number Information
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NPI Number | 1265945877
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Entity Type | Individual
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Provider Name | BREUNICA KESHAWN GRACE DPT
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Gender | Female
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Dates
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Enumeration Date | 11/06/2017
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 421 N CARROLLTON AVE STE 4
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City | NEW ORLEANS
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State | LA
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Zip | 70119-4746
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Country | US
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Telephone | 504-702-6688
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Fax | 504-702-6679
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Provider Business Mailing Address
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Address Line | 625 KENMOOR AVE SE STE 100
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City | GRAND RAPIDS
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State | MI
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Zip | 49546-2395
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Country | US
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Telephone | 616-356-5000
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Fax | 616-356-5001
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1290247
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 10417R
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License Number State | LA
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