Provider Demographics
NPI:1548334998
Name:VANBRAKLE, COURTNEY MONIQUE (DPT)
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:MONIQUE
Last Name:VANBRAKLE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3516 SW 11TH CT
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5107
Mailing Address - Country:US
Mailing Address - Phone:239-945-5159
Mailing Address - Fax:239-945-0396
Practice Address - Street 1:3516 SW 11TH CT
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-5107
Practice Address - Country:US
Practice Address - Phone:239-945-5159
Practice Address - Fax:239-945-0396
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT20570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist