=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982855391
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BRAVIS ENTERPRISES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2008
-----------------------------------------------------
Last Update Date | 01/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 316 1ST AVE SUITE 200
-----------------------------------------------------
City | KITTANNING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16201-2264
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-543-1457
-----------------------------------------------------
Fax | 724-543-1458
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 RENAISSANCE DR SUITE 301
-----------------------------------------------------
City | BUTLER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16001-7612
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-282-0755
-----------------------------------------------------
Fax | 724-282-7723
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. CINDY S MURPHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 724-282-0755
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR0401X
-----------------------------------------------------
Taxonomy Name | Comprehensive Outpatient Rehabilitation Facility (CORF)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------