MEDICARE: BRECK ALAN MITCHELL 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
1	225100000X	Physical Therapist	2020037945	MO

General Provider Information

NPI Number	:	1629670328
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRECK ALAN MITCHELL PT, DPT

Provider Business Mailing Address
First Line	:	1200 CORPORATE DR STE 400
Second Line	:
City	:	HOOVER
State	:	AL
Zip	:	35242-5424
Country	:	US
Telephone Number	:	423-238-7217
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 S MADISON ST STE L
Second Line	:
City	:	WEBB CITY
State	:	MO
Zip	:	64870-2426
Country	:	US
Telephone Number	:	417-673-2156
Fax Number	:	417-673-2176

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

Provider Enumeration Date	:	11/09/2020
Last Update Date	:	06/25/2021

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