Provider Demographics
NPI:1235773755
Name:BRETON, HALLEE D
Entity Type:Individual
Prefix:
First Name:HALLEE
Middle Name:D
Last Name:BRETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 FOREST FALLS DR
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6937
Mailing Address - Country:US
Mailing Address - Phone:207-846-8725
Mailing Address - Fax:207-846-8728
Practice Address - Street 1:55 CONGRESS AVE STE 6
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-1536
Practice Address - Country:US
Practice Address - Phone:207-386-0351
Practice Address - Fax:207-386-0181
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT5482225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist