MEDICARE: DAWN NEWMAN BREKKE PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT00003984	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT00003984	OTHER	WA	PHYSICAL THERAPY LICENSE

General Provider Information

NPI Number	:	1518448976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN NEWMAN BREKKE PT

Provider Business Mailing Address
First Line	:	14512 E 45TH CT
Second Line	:
City	:	VERADALE
State	:	WA
Zip	:	99037-9143
Country	:	US
Telephone Number	:	509-951-2339
Fax Number	:

Provider Business Practice Location Address
First Line	:	3600 E HARTSON AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99202-5199
Country	:	US
Telephone Number	:	509-535-2071
Fax Number	:	509-534-6088

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	08/23/2018

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