Provider Demographics
NPI:1447482559
Name:BREITENWISCHER, ALEX A (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:A
Last Name:BREITENWISCHER
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 S UNIVERSITY PARKS DR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76706-1731
Mailing Address - Country:US
Mailing Address - Phone:254-709-9032
Mailing Address - Fax:
Practice Address - Street 1:1500 S UNIVERSITY PARKS DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-1731
Practice Address - Country:US
Practice Address - Phone:254-710-8136
Practice Address - Fax:254-710-3377
Is Sole Proprietor?:No
Enumeration Date:2009-08-23
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT16192255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
1012168OtherNATA MEMBERSHIP
2000002577OtherBOC CERTIFICATION
TXAT4649OtherSTATE LICENSE