Provider Demographics
NPI:1235135765
Name:BRESKE, NATHAN LEE (DPT, ATC)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:LEE
Last Name:BRESKE
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 4TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-6824
Mailing Address - Country:US
Mailing Address - Phone:605-753-0430
Mailing Address - Fax:605-753-2663
Practice Address - Street 1:1516 4TH ST NE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-6824
Practice Address - Country:US
Practice Address - Phone:605-753-0430
Practice Address - Fax:605-753-2663
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD4995013OtherBLUE CROSS
SD5834740Medicaid
SD436502Medicare Oscar/Certification
SD5834740Medicaid