Provider Demographics
NPI:1740246537
Name:BREAUX, JONI MARIE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:JONI
Middle Name:MARIE
Last Name:BREAUX
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88899 KNIGHT ROAD
Mailing Address - Street 2:
Mailing Address - City:VENETA
Mailing Address - State:OR
Mailing Address - Zip Code:97487
Mailing Address - Country:US
Mailing Address - Phone:541-935-2068
Mailing Address - Fax:
Practice Address - Street 1:911 COUNTRY CLUB RD
Practice Address - Street 2:SUITE 150
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-683-5139
Practice Address - Fax:541-683-5783
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7394225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant