Provider Demographics
NPI:1093863862
Name:BRAGG, JULIE (CFOM, CPED)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BRAGG
Suffix:
Gender:F
Credentials:CFOM, CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 BARRETT DR STE 102
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27609-7220
Mailing Address - Country:US
Mailing Address - Phone:919-441-0023
Mailing Address - Fax:919-594-1175
Practice Address - Street 1:3824 BARRETT DR STE 102
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7220
Practice Address - Country:US
Practice Address - Phone:
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy Fitter
No224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC046KYOtherBCBS
NC7703875Medicaid
NC7795286Medicaid
NC7795259Medicaid
NC046KYOtherBCBS
NC1179580002Medicare NSC