Active NPI
Derrick Steven Breeden, DPT
- Physical Therapist
- Foley, MN
National Provider Identifier
1801325113
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 10647
- Practice address
- 400 Broadway Ave N
Foley, MN 56329-8794 - Phone
- (320) 968-4677
- NPI assigned
- Jun 8, 2017
- Last updated
- Jun 8, 2017
- Sex
- Male
- 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 | 10647 | MN | Primary |
Addresses
Primary practice location
400 Broadway Ave N
Foley, MN 56329-8794
Mailing address
1855 Highway 47
Ogilvie, MN 56358-9080
Phone (612) 910-1589
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10647 | MN | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1496880000000",
"number": "1801325113",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1855 HIGHWAY 47",
"city": "OGILVIE",
"state": "MN",
"postal_code": "563589080",
"telephone_number": "612-910-1589"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 BROADWAY AVE N",
"city": "FOLEY",
"state": "MN",
"postal_code": "563298794",
"telephone_number": "320-968-4677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREEDEN",
"first_name": "DERRICK",
"middle_name": "STEVEN",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-06-08",
"last_updated": "2017-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MN",
"license": "10647",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Foley, MN
- Authentic Heart Counseling LLC
- Benton County (Benton County Human Services)
- Benton County (Benton County Public Health)
- Best Begins With Home LLC
- Mischelle Blenkush, CCC-SLP
- Jason Brule
- Centracare Clinic (CentraCare quickClinic - Foley)
- Centracare Clinic (CentraCare Clinic - Foley)
- Coborns Inc (Coborns Pharmacy #2002)
- County of Benton Ind School Dist 51
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.