Basic Information
| Provider Information | |||||||||
| NPI: | 1902966781 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EPPLER | ||||||||
| FirstName: | BREANNA | ||||||||
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| Credential: | P.T., DPT, CSCS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 280 DOBBS FERRY RD | ||||||||
| Address2: | SUITE #209 | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106071900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144289698 | ||||||||
| FaxNumber: | 9144286013 | ||||||||
| Practice Location | |||||||||
| Address1: | 280 DOBBS FERRY RD | ||||||||
| Address2: | SUITE #209 | ||||||||
| City: | WHITE PLAINS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 106071900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144289698 | ||||||||
| FaxNumber: | 9144286013 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 10/05/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 028078-1 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | Q4W9X1 | 01 | NY | MEDICARE GROUP ID | OTHER |