1336431121 NPI number — MRS. AMY BETH BREUNINGER AMY BREUNINGER, P.T.

Table of content: MRS. AMY BETH BREUNINGER AMY BREUNINGER, P.T. (NPI 1336431121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336431121 NPI number — MRS. AMY BETH BREUNINGER AMY BREUNINGER, P.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BREUNINGER
Provider First Name:
AMY
Provider Middle Name:
BETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AMY BREUNINGER, P.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336431121
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2319 SUMMERCREEK DR APT 49
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA ROSA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95404-7768
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-343-9461
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3975 OLD REDWOOD HWY
Provider Second Line Business Practice Location Address:
MOB 5 SUITE 154
Provider Business Practice Location Address City Name:
SANTA ROSA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95403-1719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-566-5858
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT37672 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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