Provider Demographics
NPI:1518246156
Name:BRATTON, SHIRLEY ANNE (PT)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANNE
Last Name:BRATTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34218 ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-4465
Mailing Address - Country:US
Mailing Address - Phone:352-638-3522
Mailing Address - Fax:
Practice Address - Street 1:34218 ISLAND DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-4465
Practice Address - Country:US
Practice Address - Phone:352-638-3522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-14
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2405225100000X
FL1038225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist