Provider Demographics
NPI:1326471053
Name:BREITBACH, MARCI (PTA)
Entity Type:Individual
Prefix:
First Name:MARCI
Middle Name:
Last Name:BREITBACH
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 S 13TH ST
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-3727
Mailing Address - Country:US
Mailing Address - Phone:406-222-3541
Mailing Address - Fax:406-823-6287
Practice Address - Street 1:601 ROBIN LN
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:MT
Practice Address - Zip Code:59047-3810
Practice Address - Country:US
Practice Address - Phone:406-222-7231
Practice Address - Fax:406-222-2435
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2029 PTA225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant