Provider Demographics
NPI:1942280813
Name:BRAGA, MATTHEW D (RPT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:D
Last Name:BRAGA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21090 VIA SANDIA
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-9588
Mailing Address - Country:US
Mailing Address - Phone:541-728-3412
Mailing Address - Fax:541-610-1504
Practice Address - Street 1:2753 NW LOLO DR
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7288
Practice Address - Country:US
Practice Address - Phone:541-728-3412
Practice Address - Fax:541-610-1504
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24507174400000X
OR61792225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19929ZMedicare ID - Type Unspecified