Provider Demographics
NPI:1376394270
Name:BRIECKE, JESSICA J (LMT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:J
Last Name:BRIECKE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 DELLWOOD CT
Mailing Address - Street 2:
Mailing Address - City:WESTTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10998-3805
Mailing Address - Country:US
Mailing Address - Phone:845-726-3646
Mailing Address - Fax:
Practice Address - Street 1:53 DELLWOOD CT
Practice Address - Street 2:
Practice Address - City:WESTTOWN
Practice Address - State:NY
Practice Address - Zip Code:10998-3805
Practice Address - Country:US
Practice Address - Phone:845-726-3646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010410-01225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist