Basic Information
| Provider Information | |||||||||
| NPI: | 1003149428 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRATTON | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | NEIL | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 445 S COUNTY ROAD 525 E | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461238361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177452522 | ||||||||
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| Practice Location | |||||||||
| Address1: | 445 S COUNTY ROAD 525 E | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461238361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177452522 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2009 | ||||||||
| LastUpdateDate: | 09/16/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 06002043A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.