Provider Demographics
NPI:1679616866
Name:BRAMBLE, MARK WILLIAM (ATC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WILLIAM
Last Name:BRAMBLE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 ELISHA DR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-2048
Mailing Address - Country:US
Mailing Address - Phone:609-259-9358
Mailing Address - Fax:609-259-9359
Practice Address - Street 1:12 ELISHA DR
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08501-2048
Practice Address - Country:US
Practice Address - Phone:609-259-9358
Practice Address - Fax:609-259-9359
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MT000251002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer