Provider Demographics
NPI:1346031507
Name:BRECKENRIDGE, COLLIN (DPT)
Entity type:Individual
Prefix:
First Name:COLLIN
Middle Name:
Last Name:BRECKENRIDGE
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 1:208 KING ST
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64463-9644
Mailing Address - Country:US
Mailing Address - Phone:660-483-0387
Mailing Address - Fax:
Practice Address - Street 1:16990 W 86 STREET
Practice Address - Street 2:STE 110
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66219
Practice Address - Country:US
Practice Address - Phone:913-530-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist