Karen A Brasesco, P.T.

Individual provider Active NPI Physical Therapist · Sonora, CA

NPI 1376764993 · NPPES record last updated Jul 8, 2007

Key facts

NPI
1376764993
Entity type
Individual (NPI type 1)
Primary specialty
Physical Therapist 225100000X
License
PT13166 (CA)
Practice address
181 So. Fairview Lane
Sonora, CA 95370
Phone
(209) 532-6463
Fax
(209) 532-3420
NPI assigned
May 1, 2007
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
Yes

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X PT13166 CA Yes

Addresses

Primary practice location

181 So. Fairview Lane
Sonora, CA 95370

Mailing address

P.O. Box 1639
Twain Harte, CA 95383-1639
Phone (209) 627-5136

Other names

  • Karen A Deramo Former name

Other providers in Sonora, CA

All providers in Sonora, CA · Physical Therapist in California

Sources for this page

Verify at the official NPI Registry.