Provider Demographics
NPI:1487888715
Name:SCARPELLA, BREANNA (DPT)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:SCARPELLA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 CALIFORNIA AVE
Mailing Address - Street 2:STE 211
Mailing Address - City:WAHIAWA
Mailing Address - State:HI
Mailing Address - Zip Code:96786-1841
Mailing Address - Country:US
Mailing Address - Phone:808-622-4942
Mailing Address - Fax:808-622-1335
Practice Address - Street 1:12551 OLD GLENN HWY STE E
Practice Address - Street 2:
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577
Practice Address - Country:US
Practice Address - Phone:907-694-5515
Practice Address - Fax:907-694-5575
Is Sole Proprietor?:No
Enumeration Date:2009-05-15
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9951225100000X
HIPT5103225100000X
AK136520225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist