Provider Demographics
NPI:1982724464
Name:BRAGA, MALINDA CABRAL SR (MSPT)
Entity Type:Individual
Prefix:
First Name:MALINDA
Middle Name:CABRAL
Last Name:BRAGA
Suffix:SR
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 NEWTON ST
Mailing Address - Street 2:APT #1R
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3944
Mailing Address - Country:US
Mailing Address - Phone:617-530-0419
Mailing Address - Fax:
Practice Address - Street 1:745 TRUMAN HWY
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3536
Practice Address - Country:US
Practice Address - Phone:617-361-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15799225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist