Provider Demographics
NPI:1790370815
Name:BRUBAKER, JUDITH LABRECHE (PT)
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:LABRECHE
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:MARIE
Other - Last Name:LABRECHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17135 SANTA CRUZ CT
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-6246
Mailing Address - Country:US
Mailing Address - Phone:714-269-6987
Mailing Address - Fax:
Practice Address - Street 1:17135 SANTA CRUZ CT
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-6246
Practice Address - Country:US
Practice Address - Phone:714-269-6987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT17691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist