Provider Demographics
NPI:1902904113
Name:BRELAND, SUE JENNIFER (DPT)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:JENNIFER
Last Name:BRELAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:SUE
Other - Middle Name:JENNIFER
Other - Last Name:LIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:295 S MADISON AVE
Mailing Address - Street 2:#7
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-2870
Mailing Address - Country:US
Mailing Address - Phone:818-790-3001
Mailing Address - Fax:818-790-9732
Practice Address - Street 1:1346 FOOTHILL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2122
Practice Address - Country:US
Practice Address - Phone:818-790-3001
Practice Address - Fax:818-790-9732
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT27488225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT27488AMedicare ID - Type Unspecified