Provider Demographics
NPI:1447356977
Name:BRECHT, BRIAN EUGENE (MS, PT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:EUGENE
Last Name:BRECHT
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 INNOVATION DRIVE
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15717-8096
Mailing Address - Country:US
Mailing Address - Phone:724-343-4060
Mailing Address - Fax:724-343-4069
Practice Address - Street 1:1000 MARKET ST
Practice Address - Street 2:SUITE 11
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-2600
Practice Address - Country:US
Practice Address - Phone:570-784-1896
Practice Address - Fax:570-784-1897
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010863L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA230860OtherHEALTH AMERICA/HEALTH AS
PA7017692OtherAETNA NON-HMO
PABR1536500OtherHIGHMARK BLUE SHIELD
PA50021628OtherCAPITAL/KHPC
PA817891OtherBCNE/FPH
PA817891OtherBCNE/FPH