Provider Demographics
NPI:1346538089
Name:BRESEE, BROOKE MICHELLE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:MICHELLE
Last Name:BRESEE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3637 150TH AVE
Mailing Address - Street 2:
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-8138
Mailing Address - Country:US
Mailing Address - Phone:641-777-1461
Mailing Address - Fax:
Practice Address - Street 1:3637 150TH AVE
Practice Address - Street 2:
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-8138
Practice Address - Country:US
Practice Address - Phone:641-777-1461
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004801225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant