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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Other - Last Name:
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Mailing Address - Street 1:2300 KINSALE POINT
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-6756
Mailing Address - Country:US
Mailing Address - Phone:678-469-3007
Mailing Address - Fax:404-350-9405
Practice Address - Street 1:2300 KINSALE POINT
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-6756
Practice Address - Country:US
Practice Address - Phone:678-469-3007
Practice Address - Fax:404-350-9405
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0025362251P0200X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics