Provider Demographics
NPI:1114531753
Name:BRAUNBECK, ALIVIA (MS, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:ALIVIA
Middle Name:
Last Name:BRAUNBECK
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1627 BAER AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-4204
Mailing Address - Country:US
Mailing Address - Phone:570-447-6396
Mailing Address - Fax:
Practice Address - Street 1:1627 BAER AVE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-4204
Practice Address - Country:US
Practice Address - Phone:570-447-6396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer