Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT09462 | OH |
N | 2251X0800X | Physical Therapist - Orthopedic | 17780 | MA |
NPI | 1043396872 |
---|---|
Provider Name | Scott Braje |
First Address | Peabody, MA 01960-1668 |
Second Address | Peabody, MA 01960-1668 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000356111 | BC/BS (01) | OH |
0108341 | (05) | OH |
382617193-63 | BWC (01) | OH |