Provider Demographics
NPI:1326360835
Name:BRAEM, BARRIE ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:BARRIE
Middle Name:ELIZABETH
Last Name:BRAEM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 CHELSEA DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-3820
Mailing Address - Country:US
Mailing Address - Phone:504-394-0202
Mailing Address - Fax:
Practice Address - Street 1:4201 WOODLAND DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-7339
Practice Address - Country:US
Practice Address - Phone:504-393-5666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA2625225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant