Provider Demographics
NPI:1841616935
Name:BRAKEMAN, DANIELLE (PT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BRAKEMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:MARIE
Other - Last Name:GWIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7779
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93290-7779
Mailing Address - Country:US
Mailing Address - Phone:559-733-2478
Mailing Address - Fax:559-733-2470
Practice Address - Street 1:5533 W HILLSDALE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5138
Practice Address - Country:US
Practice Address - Phone:559-733-2478
Practice Address - Fax:559-733-2470
Is Sole Proprietor?:No
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41059225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist