Provider Demographics
NPI:1316292022
Name:BRAVO-LOWERY, KATRINA MARIE (PTA)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:MARIE
Last Name:BRAVO-LOWERY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9454 SILVER BUTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5657
Mailing Address - Country:US
Mailing Address - Phone:407-256-1954
Mailing Address - Fax:
Practice Address - Street 1:9454 SILVER BUTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5657
Practice Address - Country:US
Practice Address - Phone:407-256-1954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA22178225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant