Provider Demographics
NPI:1851329676
Name:BRAGG, KATHRYN G (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:G
Last Name:BRAGG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 SOUTH BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1147
Mailing Address - Country:US
Mailing Address - Phone:757-227-3820
Mailing Address - Fax:757-226-9021
Practice Address - Street 1:4525 SOUTH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1147
Practice Address - Country:US
Practice Address - Phone:757-227-3820
Practice Address - Fax:757-226-9021
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305002153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA322657OtherBLUE CROSS BLUE SHIELD
VA25181OtherSENTARA/ OPTIMA