Mary Ann Breault, LPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070009033 Issued in IL

Practice address

1941 Harlem Rd
Loves Park, IL 61111-2747

Phone

(815) 986-4411

Fax

(815) 986-4414

NPI assigned

Feb 26, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1172448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215063193",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1941 HARLEM RD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611112747",
            "telephone_number": "815-986-4411",
            "fax_number": "815-986-4414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1941 HARLEM RD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611112747",
            "telephone_number": "815-986-4411",
            "fax_number": "815-986-4414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREAULT",
        "first_name": "MARY",
        "middle_name": "ANN",
        "credential": "LPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070009033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "10132053",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "020654168",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LISCENSE",
            "identifier": "070009033",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stanislav Brandis, M.D.
• Dana Marie Brasher, RN
• Jennifer Bravo, P.T.
• Julius Bravo, DPT
• Breault Physical Therapy PC
• Lisa A. Breisch, PSY.D.
• Cortney Marie Brent
• Bridgeway Inc.
• Bridgewood Counseling
• Sarah Briggs

• Physical Therapist in Loves Park, IL
• Providers in Loves Park, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.