Provider Demographics
NPI:1356523609
Name:BRAUN, ANNA MARIE MATTHEWS (LAT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE MATTHEWS
Last Name:BRAUN
Suffix:
Gender:F
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ALLEN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2344
Mailing Address - Country:US
Mailing Address - Phone:314-961-3787
Mailing Address - Fax:314-961-0974
Practice Address - Street 1:20 ALLEN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:WEBSTER GROVES
Practice Address - State:MO
Practice Address - Zip Code:63119-2344
Practice Address - Country:US
Practice Address - Phone:314-961-3787
Practice Address - Fax:314-961-0974
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20070320462255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer