Provider Demographics
NPI:1053462184
Name:BRAGENZER, PAUL ERIC (ATC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ERIC
Last Name:BRAGENZER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1197 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-9714
Mailing Address - Country:US
Mailing Address - Phone:231-348-2024
Mailing Address - Fax:
Practice Address - Street 1:930 S STATE RD STE 10
Practice Address - Street 2:
Practice Address - City:HARBOR SPRINGS
Practice Address - State:MI
Practice Address - Zip Code:49740-1166
Practice Address - Country:US
Practice Address - Phone:231-242-0791
Practice Address - Fax:231-242-0913
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer