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BREANNA LEE COLVIN DPT
>> Physical Therapist >> Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRegistrant NPI Number: 1306503651
Individual Registrant: BREANNA LEE COLVIN DPT
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
502 S HIGH ST RANDOLPH, WI 53956-1499 US
Tel: 570-620-6135 Fax: --
Tel: 570-620-6135 Fax: --
Contact information for business:
212 S HENRY ST APT 2 MADISON, WI 53703-4434 US
Tel: 570-620-6135 Fax: --
Tel: 570-620-6135 Fax: --
Registration Information:
NPI: 1306503651
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers Physical Therapist |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
