MEDICARE: MARY ANN BRAUNSTEIN PT

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	2251P0200X	Pediatric Physical Therapist	PT10052	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PT10052	OTHER	CA	PT STATE LICENSE

General Provider Information

NPI Number	:	1356494371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN BRAUNSTEIN PT

Provider Business Mailing Address
First Line	:	2792 WOODSTOCK RD
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-4441
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2792 WOODSTOCK RD
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-4441
Country	:	US
Telephone Number	:	562-431-6004
Fax Number	:	562-431-9854

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

Provider Enumeration Date	:	01/21/2007
Last Update Date	:	07/08/2007

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