Provider Demographics
NPI:1376792580
Name:BRAGGER, VANESSA CALLAHAN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:CALLAHAN
Last Name:BRAGGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 MCEVER RD
Mailing Address - Street 2:SUITEB
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-5500
Mailing Address - Country:US
Mailing Address - Phone:770-535-5522
Mailing Address - Fax:770-535-5522
Practice Address - Street 1:3560 MCEVER RD
Practice Address - Street 2:SUITEB
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-5500
Practice Address - Country:US
Practice Address - Phone:770-535-5522
Practice Address - Fax:770-535-5522
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMT003779225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist