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General NPI Number Information
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NPI Number | 1477384675
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Entity Type | Individual
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Provider Name | CLOVIS AIRTON MARTINS BRAGA JR.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2024
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 35910 US27 S
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City | HAINES CITY
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State | FL
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Zip | 33844
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Country | US
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Telephone | 863-421-1777
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Fax |
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Provider Business Mailing Address
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Address Line | 10618 REAGANS RUN DR
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City | CLERMONT
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State | FL
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Zip | 34711-6426
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Country | US
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Telephone | 240-849-9909
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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 | PT41927
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License Number State | FL
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