Provider Demographics
NPI:1417649674
Name:HUFFMAN, BREANNE ELYSE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:ELYSE
Last Name:HUFFMAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 SALISBURY DR
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-8378
Mailing Address - Country:US
Mailing Address - Phone:614-519-3984
Mailing Address - Fax:
Practice Address - Street 1:224 W OLENTANGY ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-8433
Practice Address - Country:US
Practice Address - Phone:614-460-9507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT020460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist