Provider Demographics
NPI:1023540689
Name:DRAKE, BRIANNA (PT, DPT)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:DRAKE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:DRAKE HILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2260 LIBERTY CT
Mailing Address - Street 2:
Mailing Address - City:BRASELTON
Mailing Address - State:GA
Mailing Address - Zip Code:30517-2561
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:755 EPPS BRIDGE PKWY
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6987
Practice Address - Country:US
Practice Address - Phone:706-995-7177
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2019-12-02
Deactivation Date:2017-12-08
Deactivation Code:
Reactivation Date:2019-12-02
Provider Licenses
StateLicense IDTaxonomies
GAPT011968225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist