Provider Demographics
NPI:1336431121
Name:BREUNINGER, AMY BETH (AMY BREUNINGER, PT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:BETH
Last Name:BREUNINGER
Suffix:
Gender:F
Credentials:AMY BREUNINGER, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 SUMMERCREEK DR APT 49
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-7768
Mailing Address - Country:US
Mailing Address - Phone:707-343-9461
Mailing Address - Fax:
Practice Address - Street 1:3975 OLD REDWOOD HWY
Practice Address - Street 2:MOB 5 SUITE 154
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1719
Practice Address - Country:US
Practice Address - Phone:707-566-5858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-11
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT37672225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist