Basic Information
| Provider Information | |||||||||
| NPI: | 1841445673 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BREESE | ||||||||
| FirstName: | UTE | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | P.T., PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 699 | ||||||||
| Address2: | |||||||||
| City: | MOUNTAIN HOME | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376840699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234336039 | ||||||||
| FaxNumber: | 4234336060 | ||||||||
| Practice Location | |||||||||
| Address1: | JOHN ROBERT BELL DR | ||||||||
| Address2: | ETSU MINI DOME | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 376141700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234394044 | ||||||||
| FaxNumber: | 4234395264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2008 | ||||||||
| LastUpdateDate: | 11/20/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT1666 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 3714470 | 01 | TN | GROUP MEDICARE | OTHER |