MEDICARE: BREANA KARLENE HILL PT, DPT, ATC

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	2255A2300X	Athletic Trainer		IA
2	225100000X	Physical Therapist	2023032287	MO

General Provider Information

NPI Number	:	1134898190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANA KARLENE HILL PT, DPT, ATC

Provider Business Mailing Address
First Line	:	1051 SW TWIN CREEK DR
Second Line	:
City	:	LEES SUMMIT
State	:	MO
Zip	:	64081-3215
Country	:	US
Telephone Number	:	712-449-8452
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 NW VESPER ST
Second Line	:
City	:	BLUE SPRINGS
State	:	MO
Zip	:	64014-2745
Country	:	US
Telephone Number	:	712-449-8452
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2021
Last Update Date	:	09/27/2024

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