MEDICARE: MS. LOUISE MARIE BRAUNBECK PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	9719A	AZ

General Provider Information

NPI Number	:	1235551904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LOUISE MARIE BRAUNBECK PTA

Provider Business Mailing Address
First Line	:	16649 S 24TH PLACE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048
Country	:	US
Telephone Number	:	480-234-9832
Fax Number	:

Provider Business Practice Location Address
First Line	:	16649 S 24TH PLACE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85048
Country	:	US
Telephone Number	:	480-234-9832
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2014
Last Update Date	:	01/11/2026

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