Healthcare Provider Details

I. General information

NPI: 1881668903
Provider Name (Legal Business Name): BRAATEN HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4360 7TH ST
MOLINE IL
61265-6867
US

IV. Provider business mailing address

PO BOX 3488
DAVENPORT IA
52808-3488
US

V. Phone/Fax

Practice location:
  • Phone: 309-762-6676
  • Fax: 309-762-6684
Mailing address:
  • Phone: 563-327-0132
  • Fax: 563-359-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANNETTE DAWN LANE
Title or Position: ADMINISTRATIVE OFFICE
Credential:
Phone: 563-327-0132