| Doctor Name: | MR. ROSS JOSEPH BRAKEVILLE |
| NPI Number: | 1013997139 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.P.T. |
| License Number: | 002536 |
| Business Practice Address: | 1816 Eagle Dr Building 100, Suite C Woodstock, GA - 301898272 |
| Business Phone Number: | 7705169191 |
| Business Fax Number: | 6788027377 |
| Mailing Address: | 1816 Eagle Dr, Building 100, Suite C WOODSTOCK |
| State: | GA |
| Postal Code: | 301898272 |
| Phone Number: | 7705169191 |
| Fax Number: | 6788027377 |
| NPI Enumeration Date: | 01/17/2006 |
| NPI Last Update Date: | 02/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2251P0200X |
| License Number: | 002536 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |