Provider Demographics
NPI:1912002643
Name:PRIBYL, BRECK MARIE (MSPT)
Entity Type:Individual
Prefix:MS
First Name:BRECK
Middle Name:MARIE
Last Name:PRIBYL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 TRINITY LN N APT 7310
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-1249
Mailing Address - Country:US
Mailing Address - Phone:727-599-6930
Mailing Address - Fax:
Practice Address - Street 1:508 S HABANA AVE STE 140
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4190
Practice Address - Country:US
Practice Address - Phone:813-877-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist