MEDICARE: KAYLA BRAUN DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1174002505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLA BRAUN DPT

Provider Business Mailing Address
First Line	:	285 PARK AVE APT 7208
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-4218
Country	:	US
Telephone Number	:	330-554-3986
Fax Number	:

Provider Business Practice Location Address
First Line	:	2451B US HIGHWAY 17
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3397
Country	:	US
Telephone Number	:	912-554-5612
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2018
Last Update Date	:	08/07/2018

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Directions to “ KAYLA BRAUN DPT” Practice Location

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