Provider Demographics
NPI:1407014566
Name:HIRSCH, BREENA SUE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BREENA
Middle Name:SUE
Last Name:HIRSCH
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 1:11104 184TH AVENUE PL E
Mailing Address - Street 2:
Mailing Address - City:BONNEY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98391-6044
Mailing Address - Country:US
Mailing Address - Phone:253-862-4708
Mailing Address - Fax:
Practice Address - Street 1:920 12TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-4920
Practice Address - Country:US
Practice Address - Phone:253-841-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1776225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant