Provider Demographics
NPI:1316603350
Name:BRAGDON, KATHERINE SUSAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:SUSAN
Last Name:BRAGDON
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 1:31 GORE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1211
Mailing Address - Country:US
Mailing Address - Phone:774-722-4484
Mailing Address - Fax:
Practice Address - Street 1:500 W CUMMINGS PARK STE 2100
Practice Address - Street 2:
Practice Address - City:WOBURN
Practice Address - State:MA
Practice Address - Zip Code:01801-6513
Practice Address - Country:US
Practice Address - Phone:781-305-4656
Practice Address - Fax:781-305-4658
Is Sole Proprietor?:No
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA25866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist