Breault Physical Therapy PC

Primary specialty

Physical TherapistTaxonomy code 225100000X

Legal business name

BREAULT PHYSICAL THERAPY PC

Practice address

1820 Windsor Rd
Suite B
Loves Park, IL 61111-4271

Phone

(815) 986-4411

Fax

(815) 986-4414

NPI assigned

Aug 24, 2006

Last updated

Sep 11, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Mary Ann Breault, LPT

Title

President

Phone

(815) 986-4411

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189468800000",
    "number": "1437266327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1820 WINDSOR RD",
            "address_2": "SUITE B",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611114271",
            "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": "1820 WINDSOR RD",
            "address_2": "SUITE B",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611114271",
            "telephone_number": "815-986-4411",
            "fax_number": "815-986-4414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAULT PHYSICAL THERAPY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2007-09-11",
        "status": "A",
        "authorized_official_last_name": "BREAULT",
        "authorized_official_first_name": "MARY ANN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-986-4411",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eugene E. Brander, DDS, PC
• Stanislav Brandis, M.D.
• Dana Marie Brasher, RN
• Jennifer Bravo, P.T.
• Julius Bravo, DPT
• Mary Ann Breault, LPT
• Lisa A. Breisch, PSY.D.
• Cortney Marie Brent
• Bridgeway Inc.
• Bridgewood Counseling

• 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 Sep 11, 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.