Organization
BREFELD PHYSICAL THERAPY SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOAN L BREFELD PT PCS (PRESIDENT)
(618) 236-7588
Entity
Organization
Contact information
Practice address
106 LINCOLN PLACE CT, BELLEVILLE, IL 62221-5884
(618) 236-7588
(618) 236-7589
Mailing address
106 LINCOLN PLACE CT, BELLEVILLE, IL 62221-5884
(618) 236-7588
(618) 236-7589
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
IL
225X00000X
Occupational Therapist
—
IL
235Z00000X
Speech-Language Pathologist
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001415008
BCBS OF IL
IL
01
—
5330619
AETNA
—
Enumeration date
10/04/2005
Last updated
11/21/2007
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