Provider Demographics
NPI:1588955975
Name:REAKSECKER, BRIAN DEAN (DPT)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:DEAN
Last Name:REAKSECKER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 HARTS LAKE ROAD SOUTH
Mailing Address - Street 2:
Mailing Address - City:ROY
Mailing Address - State:WA
Mailing Address - Zip Code:98580
Mailing Address - Country:US
Mailing Address - Phone:360-458-3631
Mailing Address - Fax:
Practice Address - Street 1:2515 HARTS LAKE RD SOUTH
Practice Address - Street 2:
Practice Address - City:ROY
Practice Address - State:WA
Practice Address - Zip Code:98580-8915
Practice Address - Country:US
Practice Address - Phone:360-458-3631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist