Provider Demographics
NPI:1013997139
Name:BRAKEVILLE, ROSS JOSEPH (DPT)
Entity Type:Individual
Prefix:MR
First Name:ROSS
Middle Name:JOSEPH
Last Name:BRAKEVILLE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1816 EAGLE DR
Mailing Address - Street 2:BUILDING 100, SUITE C
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-8272
Mailing Address - Country:US
Mailing Address - Phone:770-516-9191
Mailing Address - Fax:678-802-7377
Practice Address - Street 1:1816 EAGLE DR
Practice Address - Street 2:BUILDING 100, SUITE C
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8272
Practice Address - Country:US
Practice Address - Phone:770-516-9191
Practice Address - Fax:678-802-7377
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0025362251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics