MEDICARE: BREATHE A NEW LIFE 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	227900000X	Registered Respiratory Therapist	RT10049	FL

General Provider Information

NPI Number	:	1902284672
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BREATHE A NEW LIFE INC

Provider Business Mailing Address
First Line	:	3206 ANDERSON DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34946-1617
Country	:	US
Telephone Number	:	772-332-9672
Fax Number	:

Provider Business Practice Location Address
First Line	:	3206 ANDERSON DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34946-1617
Country	:	US
Telephone Number	:	772-332-9672
Fax Number	:

Authorized Official
Title or Position	:	RESPIRATORY THERAPIST
Name	:	MR. ASHON G MOORE SR.
Credential	:	RRT
Telephone Number	:	772-332-9672

Provider Enumeration Date	:	05/13/2015
Last Update Date	:	05/13/2015

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