Provider Demographics
NPI:1851690192
Name:BREITBARTH, EMILY ELIZABETH (LMT, LAT, ATC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:ELIZABETH
Last Name:BREITBARTH
Suffix:
Gender:F
Credentials:LMT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 W 2ND AVE
Mailing Address - Street 2:APT. 12B
Mailing Address - City:INDIANOLA
Mailing Address - State:IA
Mailing Address - Zip Code:50125-2195
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 N C ST
Practice Address - Street 2:SIMPSON COLLEGE-COWLES
Practice Address - City:INDIANOLA
Practice Address - State:IA
Practice Address - Zip Code:50125-1201
Practice Address - Country:US
Practice Address - Phone:515-961-1503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-25
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000772174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator