Provider Demographics
NPI:1912947623
Name:BREAULT, KRIS T (CTRS)
Entity Type:Individual
Prefix:MS
First Name:KRIS
Middle Name:T
Last Name:BREAULT
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:PA
Mailing Address - Zip Code:15051-1005
Mailing Address - Country:US
Mailing Address - Phone:412-767-0188
Mailing Address - Fax:
Practice Address - Street 1:VAPHCS
Practice Address - Street 2:7180 HIGHLAND DRIVE
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15051
Practice Address - Country:US
Practice Address - Phone:412-365-5855
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
15977225800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA15977OtherCTRS