Basic Information
| Provider Information | |||||||||
| NPI: | 1245835685 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRAVO | ||||||||
| FirstName: | ANA | ||||||||
| MiddleName: | MELISSA | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 784 FRANKLIN AVE | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN LAKES | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 074171306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015600711 | ||||||||
| FaxNumber: | 2015600712 | ||||||||
| Practice Location | |||||||||
| Address1: | 185 N RTE 17 | ||||||||
| Address2: | |||||||||
| City: | PARAMUS | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076522963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2015600711 | ||||||||
| FaxNumber: | 2015600712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2020 | ||||||||
| LastUpdateDate: | 01/21/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 40QB00376900 | NJ | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.