Provider Demographics
NPI:1053532200
Name:BRECKONS, DAWN M (PT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:BRECKONS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:M
Other - Last Name:HOLEVINSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:17363 WARWICK BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23603
Mailing Address - Country:US
Mailing Address - Phone:757-668-6247
Mailing Address - Fax:
Practice Address - Street 1:11783 ROCK LANDING RD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-668-6247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0579006675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist