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NPI Code Detail

MEDICARE: JACQUELINE BRAATEN L/PTA

MEDICARE: JACQUELINE BRAATEN L/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
1225200000XPhysical Therapy AssistantA-3MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A-3OTHERMNPHYSICAL THERAPIST ASSISTANT

General Provider Information

NPI Number : 1457923997
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE BRAATEN L/PTA
Provider Business Mailing Address
First Line : 13620 VISTA OAKS DR SW
Second Line :
City : PILLAGER
State : MN
Zip : 56473-2491
Country : US
Telephone Number : 218-820-7539
Fax Number :
Provider Business Practice Location Address
First Line : 804 WRIGHT ST
Second Line :
City : BRAINERD
State : MN
Zip : 56401-4441
Country : US
Telephone Number : 218-829-1407
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2021
Last Update Date : 07/14/2021

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Directions to “ JACQUELINE BRAATEN L/PTA” Practice Location

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