Provider Demographics
NPI:1942494224
Name:BRETON, ROBERT P (CO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:BRETON
Suffix:
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BARRETT LN
Mailing Address - Street 2:
Mailing Address - City:UNDERHILL
Mailing Address - State:VT
Mailing Address - Zip Code:05489
Mailing Address - Country:US
Mailing Address - Phone:802-324-3691
Mailing Address - Fax:
Practice Address - Street 1:13 BARRETT LN
Practice Address - Street 2:
Practice Address - City:UNDERHILL
Practice Address - State:VT
Practice Address - Zip Code:05489
Practice Address - Country:US
Practice Address - Phone:802-324-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE003643222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist