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General NPI Number Information
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NPI Number | 1013138759
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Entity Type | Individual
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Provider Name | BENJAMIN SCOTT BRAXLEY PT, DPT
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 1821 CLIFTON RD
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City | ATLANTA
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State | GA
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Zip | 30329
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Country | US
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Telephone | 404-728-5482
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Fax |
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Provider Business Mailing Address
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Address Line | 1462 CLIFTON RD NE STE 312
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City | ATLANTA
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State | GA
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Zip | 30322-1063
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Country | US
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Telephone | 404-272-1624
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT008769
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License Number State | GA
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