Provider Demographics
NPI:1164573101
Name:BRAUND, BECKI JO (PT)
Entity Type:Individual
Prefix:
First Name:BECKI
Middle Name:JO
Last Name:BRAUND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 LONE TREE LN
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-1000
Mailing Address - Country:US
Mailing Address - Phone:608-643-2127
Mailing Address - Fax:
Practice Address - Street 1:80 1ST ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-1550
Practice Address - Country:US
Practice Address - Phone:608-643-7263
Practice Address - Fax:608-643-7667
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6125-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist