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General NPI Number Information
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NPI Number | 1245718717
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Entity Type | Individual
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Provider Name | THOMAS MICHAEL BRAATEN DPT
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Gender | Male
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 08/06/2018
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Provider Practice Location Address
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Address Line | 11375 BIG BEND RD
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City | RIVERVIEW
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State | FL
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Zip | 33579-7183
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Country | US
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Telephone | 813-672-9201
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Fax |
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Provider Business Mailing Address
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Address Line | 10265 GANDY BLVD N APT 907
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City | SAINT PETERSBURG
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State | FL
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Zip | 33702-2332
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Country | US
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Telephone | 863-236-0607
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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 | PT33817
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License Number State | FL
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