Provider Demographics
NPI:1871017228
Name:MUTHLER, BREANNE PHILLIPS (PT DPT)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:PHILLIPS
Last Name:MUTHLER
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:NICOLE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT
Mailing Address - Street 1:430 INNOVATION DR
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:685 CAREY AVE
Practice Address - Street 2:
Practice Address - City:HANOVER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18706-5489
Practice Address - Country:US
Practice Address - Phone:570-829-0539
Practice Address - Fax:570-829-4036
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025815225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist