Provider Demographics
NPI:1558319186
Name:BREUER, SHIRLEY ELIZABETH
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ELIZABETH
Last Name:BREUER
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 1:6-3 FONCINE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06074-3665
Mailing Address - Country:US
Mailing Address - Phone:860-644-4950
Mailing Address - Fax:
Practice Address - Street 1:178 HARTFORD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5986
Practice Address - Country:US
Practice Address - Phone:860-646-1561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist