Individual
KEVIN LEE BRECKENRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
620 THOMPSON AVE, WEST MEMPHIS, AR 72301-3257
(870) 702-4911
(870) 702-6386
Mailing address
515 COUNTY ROAD 713, JONESBORO, AR 72401-2336
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2260
AR
Other
Enumeration date
02/14/2011
Last updated
02/14/2011
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