Provider Demographics
NPI:1720158074
Name:BREKKEN, JILL RENE (CMT)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:RENE
Last Name:BREKKEN
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5141 W 78TH AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80030-4622
Mailing Address - Country:US
Mailing Address - Phone:303-650-9710
Mailing Address - Fax:303-650-9710
Practice Address - Street 1:5141 W 78TH AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80030-4622
Practice Address - Country:US
Practice Address - Phone:303-650-9710
Practice Address - Fax:303-650-9710
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist