Basic Information
| Provider Information | |||||||||
| NPI: | 1659943496 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BREAZEALE | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | M | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 INDIAN ROCK CT | ||||||||
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| City: | NORTH AUGUSTA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298415214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032151922 | ||||||||
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| Practice Location | |||||||||
| Address1: | 350 AUSTIN GRAYBILL RD | ||||||||
| Address2: | |||||||||
| City: | NORTH AUGUSTA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 298609251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032784272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2021 | ||||||||
| LastUpdateDate: | 07/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 4452 | SC | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.