Active NPI
Eric Daniel Breisch
- Physical Therapy Assistant
- Kokomo, IN
National Provider Identifier
1891950309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 06002365A
- Practice address
- 2800 S Dixon Rd
Kokomo, IN 46902-6403 - Phone
- (765) 455-1111
- NPI assigned
- Jul 23, 2008
- 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 Therapy Assistant | 225200000X | 06002365A | IN | Primary |
Addresses
Primary practice location
2800 S Dixon Rd
Kokomo, IN 46902-6403
Mailing address
4843 N Parkway
Kokomo, IN 46901-3940
Phone (765) 452-1138
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06002365A | IN | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1216771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216771200000",
"number": "1891950309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4843 N PARKWAY",
"city": "KOKOMO",
"state": "IN",
"postal_code": "469013940",
"telephone_number": "765-452-1138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2800 S DIXON RD",
"city": "KOKOMO",
"state": "IN",
"postal_code": "469026403",
"telephone_number": "765-455-1111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREISCH",
"first_name": "ERIC",
"middle_name": "DANIEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-07-23",
"last_updated": "2008-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "IN",
"license": "06002365A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kokomo, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.