Kevin Robert Bresnahan, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 14228 Issued in CA

Practice address

10225 Austin Drive
# 204
Spring Valley, CA 91978

Phone

(619) 670-4567

Fax

(619) 670-0200

NPI assigned

Dec 12, 2005

Last updated

Apr 20, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eggleton & Langton Physical Therapy Management Services

  • Physical Therapist
  • Encinitas, CA
  • NPI 1588610315
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1134345600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429488000000",
    "number": "1043295124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 N EL CAMINO REAL",
            "address_2": "#210",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920242811",
            "telephone_number": "760-634-0248",
            "fax_number": "760-634-1782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10225 AUSTIN DRIVE",
            "address_2": "# 204",
            "city": "SPRING VALLEY",
            "state": "CA",
            "postal_code": "91978",
            "telephone_number": "619-670-4567",
            "fax_number": "619-670-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRESNAHAN",
        "first_name": "KEVIN",
        "middle_name": "ROBERT",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-12",
        "last_updated": "2015-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "PT 14228",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Spring Valley, CA
• Providers in Spring Valley, CA by specialty
• Physical Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.