Healthcare Provider Details

I. General information

NPI: 1558291690
Provider Name (Legal Business Name): TARA BRAMEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11260 WILBUR AVE STE 101
NORTHRIDGE CA
91326-2450
US

IV. Provider business mailing address

25609 GALE DR
STEVENSON RANCH CA
91381-1670
US

V. Phone/Fax

Practice location:
  • Phone: 818-832-5656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number310166
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: