Provider Demographics
NPI:1922520410
Name:BREKKE, CLARESSA SUE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CLARESSA
Middle Name:SUE
Last Name:BREKKE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1795 ALYSHEBA WAY STE 3202
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2280
Mailing Address - Country:US
Mailing Address - Phone:859-264-8868
Mailing Address - Fax:859-264-8878
Practice Address - Street 1:1316 MINNICH RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774
Practice Address - Country:US
Practice Address - Phone:260-748-4864
Practice Address - Fax:260-749-5960
Is Sole Proprietor?:No
Enumeration Date:2017-07-17
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012951225100000X
IN05013243A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist