Active NPI
Roberta M Breidenbach, P.T.
- Physical Therapist
- Colorado Springs, CO
National Provider Identifier
1033234752
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5614
- Practice address
- 1625 Medical Center PT
Suite 100
Colorado Springs, CO 80907-8731 - Phone
- (719) 474-1404
- NPI assigned
- Mar 20, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5614 | CO | Primary |
Addresses
Primary practice location
1625 Medical Center PT
Suite 100
Colorado Springs, CO 80907-8731
Mailing address
1625 Medical Center PT
Suite 100
Colorado Springs, CO 80907-8731
Phone (719) 494-1409
Other names 1
- Roberta M Willis
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5614 | CO | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174348800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272931200000",
"number": "1033234752",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1625 MEDICAL CENTER PT",
"address_2": "SUITE 100",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809078731",
"telephone_number": "719-494-1409"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1625 MEDICAL CENTER PT",
"address_2": "SUITE 100",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809078731",
"telephone_number": "719-474-1404"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREIDENBACH",
"first_name": "ROBERTA",
"middle_name": "M",
"credential": "P.T.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-20",
"last_updated": "2010-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CO",
"license": "5614",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "ROBERTA",
"last_name": "WILLIS",
"middle_name": "M",
"credential": "PHYSICAL THERAPIST",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.