Provider Demographics
NPI:1417921511
Name:BRAATEN HEALTH, LLC
Entity Type:Organization
Organization Name:BRAATEN HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-327-0132
Mailing Address - Street 1:PO BOX 3488
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52808-3488
Mailing Address - Country:US
Mailing Address - Phone:563-327-0132
Mailing Address - Fax:563-359-5642
Practice Address - Street 1:5403 VICTORIA AVE
Practice Address - Street 2:SUITE 20
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3925
Practice Address - Country:US
Practice Address - Phone:563-327-0132
Practice Address - Fax:563-359-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedGroup - Multi-Specialty