Provider Demographics
NPI:1134374200
Name:BREKKEN, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:BREKKEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 LAKE OTIS PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99507-2033
Mailing Address - Country:US
Mailing Address - Phone:907-770-6693
Mailing Address - Fax:907-770-6697
Practice Address - Street 1:6200 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-2033
Practice Address - Country:US
Practice Address - Phone:907-770-6693
Practice Address - Fax:907-770-6697
Is Sole Proprietor?:No
Enumeration Date:2008-11-17
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK914225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant