NPIMap

Organization Active NPI

Brefeld Physical Therapy Services PC

  • Physical Therapist
  • Belleville, IL
National Provider Identifier
1053308015
Registry record updated Nov 21, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
BREFELD PHYSICAL THERAPY SERVICES PC
Practice address
106 Lincoln Place CT
Belleville, IL 62221-5884
Phone
(618) 236-7588
Fax
(618) 236-7589
NPI assigned
Oct 4, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2007

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

Authorized official

Name
Joan L Brefeld, PT PCS
Title
President
Phone
(618) 236-7588

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X IL Primary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X IL
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X IL

Addresses

Primary practice location

106 Lincoln Place CT
Belleville, IL 62221-5884

Mailing address

106 Lincoln Place CT
Belleville, IL 62221-5884
Phone (618) 236-7588

Other identifiers 2

IdentifierTypeStateIssuer
5330619OtherAETNA
0001415008OtherILBCBS OF IL

National Provider Directory

National Provider Directory

Locations

106 Lincoln Place Ct
Belleville, IL 62221
Phone (618) 236-7588

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195603200000",
    "number": "1053308015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "106 LINCOLN PLACE CT",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622215884",
            "telephone_number": "618-236-7588",
            "fax_number": "618-236-7589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 LINCOLN PLACE CT",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622215884",
            "telephone_number": "618-236-7588",
            "fax_number": "618-236-7589"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREFELD PHYSICAL THERAPY SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2007-11-21",
        "status": "A",
        "authorized_official_last_name": "BREFELD",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-236-7588",
        "authorized_official_credential": "PT PCS"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "IL",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "5330619",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF IL",
            "identifier": "0001415008",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2007; 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.