Healthcare Provider Details

I. General information

NPI: 1063336642
Provider Name (Legal Business Name): EMILY JOSEPHINE BRAUNROTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

684 VILLAGE HWY
RUSTBURG VA
24588-4374
US

IV. Provider business mailing address

1021 ELLIOTT RD
GLADYS VA
24554-3234
US

V. Phone/Fax

Practice location:
  • Phone: 434-332-3458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2204001785
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: