Provider Demographics
NPI:1598483356
Name:BRECKLEIN, KATHERINE (PT, DPT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BRECKLEIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:ELIZABETH
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2808 FOX MEADOW LANE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72404-9346
Mailing Address - Country:US
Mailing Address - Phone:870-335-2240
Mailing Address - Fax:870-931-4457
Practice Address - Street 1:2808 FOX MEADOW LANE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72404-9346
Practice Address - Country:US
Practice Address - Phone:870-335-2240
Practice Address - Fax:870-931-4457
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT5169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR287987721Medicaid