Provider Demographics
NPI:1316389133
Name:BRAGIEL, MICHAEL P (DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:BRAGIEL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1323 W DIVERSEY PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-1207
Mailing Address - Country:US
Mailing Address - Phone:773-549-2520
Mailing Address - Fax:773-549-2743
Practice Address - Street 1:4080 N MILWAUKEE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-1831
Practice Address - Country:US
Practice Address - Phone:773-545-1153
Practice Address - Fax:773-545-1568
Is Sole Proprietor?:No
Enumeration Date:2013-07-22
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8550399-2401225100000X
IL070-019956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist