Individual
BURNETT L BRAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PRSS
Contact information
Practice address
1511 WASHINGTON ST E, CHARLESTON, WV 25311-2505
(304) 741-7106
Mailing address
1514 KANAWHA BLVD W, CHARLESTON, WV 25387-2533
(304) 768-7688
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
175T00000X
—
WV
Enumeration date
01/04/2023
Last updated
01/04/2023
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