Provider Demographics
NPI:1326796525
Name:BRAYFIELD, AMBER K (PTA)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:K
Last Name:BRAYFIELD
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 1:411 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-2711
Mailing Address - Country:US
Mailing Address - Phone:618-699-3213
Mailing Address - Fax:
Practice Address - Street 1:411 S COURT ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-2711
Practice Address - Country:US
Practice Address - Phone:618-993-2138
Practice Address - Fax:618-997-3950
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160004393225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant