Provider Demographics
NPI:1003001546
Name:BRAGANO, ANN-MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:ANN-MARIE
Middle Name:
Last Name:BRAGANO
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2900
Mailing Address - Country:US
Mailing Address - Phone:707-584-3433
Mailing Address - Fax:707-584-1224
Practice Address - Street 1:1331 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2900
Practice Address - Country:US
Practice Address - Phone:707-584-3433
Practice Address - Fax:707-584-1224
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8511225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant