Provider Demographics
NPI:1952532400
Name:BRAINERD, NATALIE E (DPT)
Entity type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:E
Last Name:BRAINERD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 VERNON RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3212
Mailing Address - Country:US
Mailing Address - Phone:617-448-1030
Mailing Address - Fax:
Practice Address - Street 1:135 N BEACON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2751
Practice Address - Country:US
Practice Address - Phone:617-448-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18508225100000X
CA33887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist