MEDICARE: PAUL BRACKET PT

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	5501008854	MI

General Provider Information

NPI Number	:	1649627985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL BRACKET PT

Provider Business Mailing Address
First Line	:	2001 MINNEAPOLIS AVE STE C
Second Line	:
City	:	GLADSTONE
State	:	MI
Zip	:	49837-2060
Country	:	US
Telephone Number	:	906-428-3085
Fax Number	:	906-428-3086

Provider Business Practice Location Address
First Line	:	2001 MINNEAPOLIS AVE STE C
Second Line	:
City	:	GLADSTONE
State	:	MI
Zip	:	49837-2060
Country	:	US
Telephone Number	:	906-428-3085
Fax Number	:	906-428-3086

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

Provider Enumeration Date	:	05/17/2016
Last Update Date	:	05/17/2016

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Directions to “ PAUL BRACKET PT” Practice Location

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