Provider Demographics
NPI:1275319634
Name:ALLMENDINGER, BREANNA
Entity Type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:ALLMENDINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:BALOG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:PERRYOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15473-0295
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 UNION ST
Practice Address - Street 2:
Practice Address - City:PERRYOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15473-1808
Practice Address - Country:US
Practice Address - Phone:724-322-9008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-01
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019412225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist