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1417493727 NPI number — BREANNA BRACERO PTA

NPI Number: 1417493727
Health Care Provider/Practitioner: BREANNA BRACERO PTA

Information about “1417493727” NPI (BREANNA BRACERO PTA) exists in 1417493727 in HTML format HTML  |  1417493727 in plain Text format TXT  |  1417493727 in PDF (Portable Document Format) PDF  |  1417493727 in an XML format XML  formats.

NPI Number : 1417493727 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1417493727",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRACERO",
    "FirstName": "BREANNA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PTA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CURRY",
    "OtherFirstName": "BREANNA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "899 STATE HIGHWAY 230",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LARAMIE",
    "MailingAddressStateName": "WY",
    "MailingAddressPostalCode": "82070-8508",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "307-760-1264",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4729 STAMM LN UNIT 5",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NAMPA",
    "PracticeLocationAddressStateName": "ID",
    "PracticeLocationAddressPostalCode": "83687-5761",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "307-760-1264",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/10/2017",
    "LastUpdateDate": "03/28/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225200000X",
          "TaxonomyName": "Physical Therapy Assistant",
          "LicenseNumber": "0824",
          "LicenseNumberStateCode": "WY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225200000X",
          "TaxonomyName": "Physical Therapy Assistant",
          "LicenseNumber": "09433",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "225200000X",
          "TaxonomyName": "Physical Therapy Assistant",
          "LicenseNumber": "9155",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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