Provider Demographics
NPI:1689211989
Name:TINNEY, BRECKEN NOELLE SCHALLER (DPT)
Entity Type:Individual
Prefix:
First Name:BRECKEN
Middle Name:NOELLE SCHALLER
Last Name:TINNEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BRECKEN
Other - Middle Name:NOELLE
Other - Last Name:SCHALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-6250
Mailing Address - Fax:630-575-7450
Practice Address - Street 1:5577 MONROE ST STE A1
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2565
Practice Address - Country:US
Practice Address - Phone:419-318-8104
Practice Address - Fax:419-540-9067
Is Sole Proprietor?:No
Enumeration Date:2019-12-05
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIPENDING225100000X
MI5501019463225100000X
OHPT018372225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist