Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT05689 | OH |
N | 2251S0007X | Physical Therapist - Sports | PT05689 | OH |
N | 2251X0800X | Physical Therapist - Orthopedic | PT05689 | OH |
NPI | 1215927728 |
---|---|
Provider Name | Malinda Marie Bragg |
First Address | Ravenna, OH 44266-3218 |
Second Address | Akron, OH 44311-1064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT05689 | OT PT ATC BOARD (01) | OH |