Provider Demographics
NPI:1184927147
Name:BREEDLOVE, GERALD (DPT, ATC)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:
Last Name:BREEDLOVE
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3058 LATIMER RD
Mailing Address - Street 2:
Mailing Address - City:ROCK CREEK
Mailing Address - State:OH
Mailing Address - Zip Code:44084-9632
Mailing Address - Country:US
Mailing Address - Phone:440-563-9144
Mailing Address - Fax:
Practice Address - Street 1:3058 LATIMER RD
Practice Address - Street 2:
Practice Address - City:ROCK CREEK
Practice Address - State:OH
Practice Address - Zip Code:44084-9632
Practice Address - Country:US
Practice Address - Phone:440-563-9144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT0013055225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist