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General NPI Number Information
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NPI Number | 1881252500
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Entity Type | Individual
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Provider Name | JAMIE LEA BRISKE DPT
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Gender | Female
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 08/01/2023
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Provider Practice Location Address
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Address Line | 57950 LEAVENWORTH ST MCCONNELL AFB
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City | WICHITA
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State | KS
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Zip | 67221-3506
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Country | US
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Telephone | 316-743-5021
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Fax |
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Provider Business Mailing Address
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Address Line | 57950 LEAVENWORTH ST MCCONNELL AFB
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City | WICHITA
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State | KS
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Zip | 67221-3506
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Country | US
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Telephone | 316-743-5021
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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 | P18729
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License Number State | NC
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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 | 1315654
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License Number State | TX
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