MEDICARE: DR. BRIAN BRATERIS 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	40QA01534800	NJ

General Provider Information

NPI Number	:	1932524667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN BRATERIS DPT

Provider Business Mailing Address
First Line	:	1325 WARREN AVE
Second Line	:
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-2566
Country	:	US
Telephone Number	:	732-449-5394
Fax Number	:	732-449-7855

Provider Business Practice Location Address
First Line	:	1325 WARREN AVE
Second Line	:
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-2566
Country	:	US
Telephone Number	:	732-449-5394
Fax Number	:	732-449-7855

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

Provider Enumeration Date	:	03/05/2014
Last Update Date	:	03/05/2014

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