Provider Demographics
NPI:1255764288
Name:BREITE, SHALE A (DPT)
Entity type:Individual
Prefix:DR
First Name:SHALE
Middle Name:A
Last Name:BREITE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 GRANT ST
Mailing Address - Street 2:APT 20
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1820
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1920 HIGH ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1213
Practice Address - Country:US
Practice Address - Phone:303-331-5264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0011686273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit