Basic Information
| Provider Information | |||||||||
| NPI: | 1447356977 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRECHT | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | EUGENE | ||||||||
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| Credential: | M.S., P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 430 INNOVATION DRIVE | ||||||||
| Address2: | |||||||||
| City: | BLAIRSVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157178096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7243434060 | ||||||||
| FaxNumber: | 7243434069 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 MARKET ST | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | BLOOMSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 178152600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5707841896 | ||||||||
| FaxNumber: | 5707841897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 01/13/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT010863L | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 230860 | 01 | PA | HEALTH AMERICA/HEALTH AS | OTHER | 7017692 | 01 | PA | AETNA NON-HMO | OTHER | BR1536500 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 50021628 | 01 | PA | CAPITAL/KHPC | OTHER | 817891 | 01 | PA | BCNE/FPH | OTHER |