Provider Demographics
NPI:1811499965
Name:BRAITSCH, MICHAEL C
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:C
Last Name:BRAITSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N COTTONWOOD DR STE 108
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-4772
Mailing Address - Country:US
Mailing Address - Phone:214-702-6559
Mailing Address - Fax:469-779-1064
Practice Address - Street 1:100 N COTTONWOOD DR STE 108
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-4772
Practice Address - Country:US
Practice Address - Phone:214-702-6559
Practice Address - Fax:469-779-1064
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1286327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist