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General NPI Number Information
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NPI Number | 1558739417
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Entity Type | Individual
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Provider Name | JESSICA BRAKE DPT
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Gender | Female
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 08/10/2021
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Provider Practice Location Address
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Address Line | 5052 WATERFORD DR UNIT 102
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City | SHEFFIELD VILLAGE
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State | OH
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Zip | 44035-1497
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Country | US
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Telephone | 440-934-9950
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Fax |
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Provider Business Mailing Address
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Address Line | 5359 SANCTUARY LN
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City | SHEFFIELD VILLAGE
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State | OH
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Zip | 44054-3103
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Country | US
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Telephone | 419-203-8229
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05011892A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT016004
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License Number State | OH
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