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NPI Code Detail

MEDICARE: BREANNE NICOLE STEFAN PT, DPT

MEDICARE: BREANNE NICOLE STEFAN PT, DPT
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
1225100000XPhysical TherapistPT016061GA

General Provider Information

NPI Number : 1184504011
Entity Type Code : Individual
Provider Name (Legal Business Name) : BREANNE NICOLE STEFAN PT, DPT
Provider Business Mailing Address
First Line : 730 GLENWOOD AVE SE APT 442
Second Line :
City : ATLANTA
State : GA
Zip : 30312-3577
Country : US
Telephone Number : 770-823-4125
Fax Number :
Provider Business Practice Location Address
First Line : 3750 PEACHTREE RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30319-1385
Country : US
Telephone Number : 404-261-6611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2025
Last Update Date : 09/03/2025

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