MEDICARE: MS. BRECK MARIE PRIBYL MSPT

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	22332	FL

General Provider Information

NPI Number	:	1912002643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRECK MARIE PRIBYL MSPT

Provider Business Mailing Address
First Line	:	500 TRINITY LN N APT 7310
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33716-1249
Country	:	US
Telephone Number	:	727-599-6930
Fax Number	:

Provider Business Practice Location Address
First Line	:	508 S HABANA AVE STE 140
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4190
Country	:	US
Telephone Number	:	813-877-7200
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	10/08/2008

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