Organization
BREAULT PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY ANN BREAULT LPT (PRESIDENT)
(815) 986-4411
Entity
Organization
Contact information
Practice address
1820 WINDSOR RD, SUITE B, LOVES PARK, IL 61111-4271
(815) 986-4411
(815) 986-4414
Mailing address
1820 WINDSOR RD, SUITE B, LOVES PARK, IL 61111-4271
(815) 986-4411
(815) 986-4414
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
IL
Other
Enumeration date
08/24/2006
Last updated
09/11/2007
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