Provider Demographics
NPI:1770729659
Name:BREITBACH, RHONDA LEE (DPT)
Entity type:Individual
Prefix:
First Name:RHONDA
Middle Name:LEE
Last Name:BREITBACH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:LEE
Other - Last Name:PICKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:323 S MINNESOTA ST
Mailing Address - Street 2:
Mailing Address - City:CROOKSTON
Mailing Address - State:MN
Mailing Address - Zip Code:56716
Mailing Address - Country:US
Mailing Address - Phone:218-281-9200
Mailing Address - Fax:
Practice Address - Street 1:323 S MINNESOTA ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716
Practice Address - Country:US
Practice Address - Phone:218-281-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-26
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7747225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist