Provider Demographics
NPI:1376764993
Name:BRASESCO, KAREN A (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:A
Last Name:BRASESCO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:A
Other - Last Name:DERAMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:P.O. BOX 1639
Mailing Address - Street 2:
Mailing Address - City:TWAIN HARTE
Mailing Address - State:CA
Mailing Address - Zip Code:95383-1639
Mailing Address - Country:US
Mailing Address - Phone:209-627-5136
Mailing Address - Fax:
Practice Address - Street 1:181 SO. FAIRVIEW LANE
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370
Practice Address - Country:US
Practice Address - Phone:209-532-6463
Practice Address - Fax:209-532-3420
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist