Provider Demographics
NPI:1073350252
Name:BRAKE, ABIGAIL LAUREN (PTA)
Entity type:Individual
Prefix:MRS
First Name:ABIGAIL
Middle Name:LAUREN
Last Name:BRAKE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:ABIGAIL
Other - Middle Name:LAUREN
Other - Last Name:ALSOP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ABBY ALSOP
Mailing Address - Street 1:2218 MELROSE LN
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-3560
Mailing Address - Country:US
Mailing Address - Phone:620-290-2335
Mailing Address - Fax:
Practice Address - Street 1:631 E CRAWFORD ST STE 220
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-5116
Practice Address - Country:US
Practice Address - Phone:785-825-2323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-13
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03865225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant