Provider Demographics
NPI:1275239857
Name:FLAX, BREKK NICOLE (DPT)
Entity Type:Individual
Prefix:
First Name:BREKK
Middle Name:NICOLE
Last Name:FLAX
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 1:335 NW BARRY RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-2740
Mailing Address - Country:US
Mailing Address - Phone:816-468-5278
Mailing Address - Fax:816-285-5278
Practice Address - Street 1:6112 N HIGHWAY 9 STE B
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MO
Practice Address - Zip Code:64152-3597
Practice Address - Country:US
Practice Address - Phone:816-468-5278
Practice Address - Fax:816-285-5278
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023004386225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist