Provider Demographics
NPI:1124161617
Name:BRAUN, JESSICA LEIGH
Entity type:Individual
Prefix:MISS
First Name:JESSICA
Middle Name:LEIGH
Last Name:BRAUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 GEARY BLVD FL 4
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3101
Mailing Address - Country:US
Mailing Address - Phone:415-833-2454
Mailing Address - Fax:
Practice Address - Street 1:4131 GEARY BLVD FL 4
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3101
Practice Address - Country:US
Practice Address - Phone:415-833-2454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010935225100000X
CA29743225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist