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NPI Code Detail

MEDICARE: DR. KAMA NICOLE BRAGG PT, DPT

MEDICARE: DR. KAMA NICOLE BRAGG PT, DPT
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
12251P0200XPediatric Physical Therapist2305207529VA

General Provider Information

NPI Number : 1932454295
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KAMA NICOLE BRAGG PT, DPT
Provider Business Mailing Address
First Line : 11240 WAPLES MILL RD STE 202
Second Line :
City : FAIRFAX
State : VA
Zip : 22030-6078
Country : US
Telephone Number : 703-237-2219
Fax Number :
Provider Business Practice Location Address
First Line : 3625 CITADEL DR S
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80909-5320
Country : US
Telephone Number : 719-597-0822
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/23/2012
Last Update Date : 07/23/2020

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