Provider Demographics
NPI:1417493727
Name:BRACERO, BREANNA (PTA)
Entity type:Individual
Prefix:
First Name:BREANNA
Middle Name:
Last Name:BRACERO
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:
Other - Last Name:CURRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:899 STATE HIGHWAY 230
Mailing Address - Street 2:
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-8508
Mailing Address - Country:US
Mailing Address - Phone:307-760-1264
Mailing Address - Fax:
Practice Address - Street 1:4729 STAMM LN UNIT 5
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5761
Practice Address - Country:US
Practice Address - Phone:307-760-1264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY0824225200000X
OR09433225200000X
ID9155225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant