Provider Demographics
NPI:1629008883
Name:BRACES R US, INCORPORATED
Entity Type:Organization
Organization Name:BRACES R US, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:419-366-6303
Mailing Address - Street 1:3317 HARVEST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1067
Mailing Address - Country:US
Mailing Address - Phone:419-366-6303
Mailing Address - Fax:419-433-0604
Practice Address - Street 1:4806 TIMBER COMMONS DR
Practice Address - Street 2:SUITE C
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7161
Practice Address - Country:US
Practice Address - Phone:419-621-1166
Practice Address - Fax:419-627-4263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT- 5557225100000X
OH22030630332B00000X
OH22 030 630332BC3200X
OHPT -5557335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Not Answered335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH11550039OtherCAQH #
OH269 4679Medicaid
OH268 4877Medicaid
OHAL 418 6011Medicare ID - Type UnspecifiedINDIVIDUAL
OH268 4877Medicaid
OH269 4679Medicaid