Provider Demographics
NPI:1235560863
Name:BRAUN, KIM (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BRAUN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12545 SW CABALLERO CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7705
Mailing Address - Country:US
Mailing Address - Phone:503-319-0333
Mailing Address - Fax:877-580-3642
Practice Address - Street 1:12545 SW CABALLERO CT
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7705
Practice Address - Country:US
Practice Address - Phone:503-319-0333
Practice Address - Fax:877-580-3642
Is Sole Proprietor?:No
Enumeration Date:2013-12-08
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14912225100000X
OR2345225100000X
WA00005627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist