Provider Demographics
NPI:1023270204
Name:BRAUN, RYAN WILLIAM (DPT)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:WILLIAM
Last Name:BRAUN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:DR
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:BRAUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:4305 W EMPEDRADO ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6603
Mailing Address - Country:US
Mailing Address - Phone:813-317-8865
Mailing Address - Fax:
Practice Address - Street 1:4305 W EMPEDRADO ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-6603
Practice Address - Country:US
Practice Address - Phone:813-317-8865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist