Individual
SUSAN M BRAKEFIELD
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1234 WHITEFISH STAGE, KALISPELL, MT 59901-2753
(406) 756-7878
(406) 257-7811
Mailing address
1234 WHITEFISH STAGE, KALISPELL, MT 59901-2753
(406) 756-7878
(406) 257-7811
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
352PT
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0343317
—
MT
01
—
BCBS OF MT
PROVIDER NUMBER
MT
01
—
MT STATE FUND COMP
PROVIDER NUMBER
MT
01
—
WA STATE WORK COMP
PROVIDER # WA ST PATIENTS
MT
Enumeration date
10/14/2005
Last updated
07/09/2007
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