Provider Demographics
NPI:1659548014
Name:BRAUN-JOHNSON, TERRIE (PTA)
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:
Last Name:BRAUN-JOHNSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 CARDINAL ST NW
Mailing Address - Street 2:PO BOX 235
Mailing Address - City:BANGOR
Mailing Address - State:WI
Mailing Address - Zip Code:54614-6705
Mailing Address - Country:US
Mailing Address - Phone:608-486-2027
Mailing Address - Fax:
Practice Address - Street 1:614 S ROCK AVE
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1936
Practice Address - Country:US
Practice Address - Phone:608-637-2171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI649-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant