MEDICARE: ROBERT BREINGAN

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	PT008478	GA

General Provider Information

NPI Number	:	1942761150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BREINGAN

Provider Business Mailing Address
First Line	:	720 TRANSIT AVE STE 102
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-2544
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 TRANSIT AVE
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-2540
Country	:	US
Telephone Number	:	770-720-5127
Fax Number	:

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

Provider Enumeration Date	:	03/29/2019
Last Update Date	:	03/29/2019

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