Janice Gail Brackenbury, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

06001592A Issued in IN

Practice address

16200 19 Mile Rd
Clinton Township, MI 48038-1103

Phone

(586) 416-2065

Fax

(586) 228-7159

NPI assigned

May 21, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1710195698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2818 SERRA DR",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483105257",
            "telephone_number": "586-977-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16200 19 MILE RD",
            "city": "CLINTON TOWNSHIP",
            "state": "MI",
            "postal_code": "480381103",
            "telephone_number": "586-416-2065",
            "fax_number": "586-228-7159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACKENBURY",
        "first_name": "JANICE",
        "middle_name": "GAIL",
        "name_prefix": "Mrs.",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IN",
            "license": "06001592A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicholas James Bournias, DDS
• Samantha Boutin, LMSW
• Mary Bowers
• Rebecca Bowman
• Regina Boyd, P.T.A.
• Eileen Bradychok, MA, LPC, LBSW
• Xhenis Brahimi, DO
• Jon T Braman, CRNA
• Braswell Family Dentistry, PLC
• Melissa Braswell, DDS

• Physical Therapy Assistant in Clinton Township, MI
• Providers in Clinton Township, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.