MEDICARE: JOHN L. BRAUN, PT,PC

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	225100000X	Physical Therapist	008220-1	NY

General Provider Information

NPI Number	:	1316216245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN L. BRAUN, PT,PC

Provider Business Mailing Address
First Line	:	2024 DEER PARK AVE
Second Line	:
City	:	DEER PARK
State	:	NY
Zip	:	11729-2701
Country	:	US
Telephone Number	:	631-243-0247
Fax Number	:	631-243-0248

Provider Business Practice Location Address
First Line	:	2024 DEER PARK AVE
Second Line	:
City	:	DEER PARK
State	:	NY
Zip	:	11729-2701
Country	:	US
Telephone Number	:	631-243-0247
Fax Number	:	631-243-0248

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	EVELYN R. BRAUN
Credential	:
Telephone Number	:	631-243-0247

Provider Enumeration Date	:	12/21/2011
Last Update Date	:	12/21/2011

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