Provider Demographics
NPI:1396856597
Name:BRAUNER, EVE FREUNDLICH (PT)
Entity Type:Individual
Prefix:MRS
First Name:EVE
Middle Name:FREUNDLICH
Last Name:BRAUNER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:EVE
Other - Middle Name:DONNA
Other - Last Name:FREUNDLICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:77 RIPLEY ST
Mailing Address - Street 2:C/O T DREXLER
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459
Mailing Address - Country:US
Mailing Address - Phone:617-527-9767
Mailing Address - Fax:
Practice Address - Street 1:77 RIPLEY ST
Practice Address - Street 2:C/O T DREXLER
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-527-9767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPT 0197Medicare ID - Type Unspecified