Healthcare Provider Details

I. General information

NPI: 1629002977
Provider Name (Legal Business Name): WENDY ANN BRAAT PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 LATHROP ST STE 222
FAIRBANKS AK
99701-5942
US

IV. Provider business mailing address

1919 LATHROP ST STE 222
FAIRBANKS AK
99701-5942
US

V. Phone/Fax

Practice location:
  • Phone: 907-456-5990
  • Fax: 907-456-7418
Mailing address:
  • Phone: 907-456-5990
  • Fax: 907-456-7418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number232
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: