Basic Information
| Provider Information | |||||||||
| NPI: | 1225363807 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAUER | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | PT, DPT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | PHELPS | ||||||||
| OtherFirstName: | NANCY | ||||||||
| OtherMiddleName: | M | ||||||||
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| OtherCredential: | PT, DPT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 200 SOMERSET STREET | ||||||||
| Address2: | PHYSICAL THERAPY DEPARTMENT | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08901 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 SOMERSET STREET | ||||||||
| Address2: | PHYSICAL THERAPY DEPARTMENT | ||||||||
| City: | NEW BRUNSWICK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322587000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2009 | ||||||||
| LastUpdateDate: | 10/15/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 40QA01333600 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 024527 | NY | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.