Provider Demographics
NPI:1609911155
Name:BRATTON, MARC E (MS, PT, ATC)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:E
Last Name:BRATTON
Suffix:
Gender:M
Credentials:MS, PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 BRECKENRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-5328
Mailing Address - Country:US
Mailing Address - Phone:985-649-7044
Mailing Address - Fax:985-641-5825
Practice Address - Street 1:1346 LINDBERG DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-8081
Practice Address - Country:US
Practice Address - Phone:985-641-5825
Practice Address - Fax:985-641-5895
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA03642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4H225Medicare ID - Type Unspecified