Provider Demographics
NPI:1780701425
Name:BRALEY, RENEE ALVEY (ATC, LAT)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:ALVEY
Last Name:BRALEY
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 KALURNA CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-3058
Mailing Address - Country:US
Mailing Address - Phone:407-760-9619
Mailing Address - Fax:
Practice Address - Street 1:3403 TECHNOLOGICAL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1476
Practice Address - Country:US
Practice Address - Phone:812-719-1734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 21342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer