Provider Demographics
NPI:1841445673
Name:BREESE, UTE H (PT, PHD)
Entity type:Individual
Prefix:
First Name:UTE
Middle Name:H
Last Name:BREESE
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684-0699
Mailing Address - Country:US
Mailing Address - Phone:423-433-6039
Mailing Address - Fax:423-433-6060
Practice Address - Street 1:JOHN ROBERT BELL DR
Practice Address - Street 2:ETSU MINI DOME
Practice Address - City:JOHNSON CITY
Practice Address - State:NC
Practice Address - Zip Code:37614-1700
Practice Address - Country:US
Practice Address - Phone:423-439-4044
Practice Address - Fax:423-439-5264
Is Sole Proprietor?:No
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT1666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3714470OtherGROUP MEDICARE