MEDICARE: BRELAND HEALTH & REHAB GROUP INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	OK2429	OK
2	225100000X	Physical Therapist	640900000	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	376591	OTHER	OK	OKLAHOMA MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	1008356996A	OTHER	CRAIG MCBRIDE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013036508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRELAND HEALTH & REHAB GROUP INC.

Provider Business Mailing Address
First Line	:	208 S RED RIVER EXPY
Second Line	:	STE E
City	:	BURKBURNETT
State	:	TX
Zip	:	76354-3752
Country	:	US
Telephone Number	:	940-569-3630
Fax Number	:	940-569-3752

Provider Business Practice Location Address
First Line	:	1320 NW HOMESTEAD DR
Second Line	:	STE E
City	:	LAWTON
State	:	OK
Zip	:	73505-5243
Country	:	US
Telephone Number	:	580-353-6300
Fax Number	:	580-353-6319

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. BRENDA SUE BRELAND
Credential	:
Telephone Number	:	940-569-3630

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/26/2011

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Directions to “BRELAND HEALTH & REHAB GROUP INC. ” Practice Location

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