Provider Demographics
NPI:1689877672
Name:BRATEN, MAXINE TOBY (PT, MS)
Entity Type:Individual
Prefix:MRS
First Name:MAXINE
Middle Name:TOBY
Last Name:BRATEN
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 GRAENEST RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2928
Mailing Address - Country:US
Mailing Address - Phone:203-834-8899
Mailing Address - Fax:203-761-1907
Practice Address - Street 1:66 GROVE ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4112
Practice Address - Country:US
Practice Address - Phone:203-438-1898
Practice Address - Fax:203-438-1864
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist