Provider Demographics
NPI:1588771091
Name:BRAWLEY, MARTINA
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:BRAWLEY
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 1:763 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BOUND BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:08805-1508
Mailing Address - Country:US
Mailing Address - Phone:908-563-0475
Mailing Address - Fax:
Practice Address - Street 1:1200 US HIGHWAY 22 STE 2
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2943
Practice Address - Country:US
Practice Address - Phone:908-722-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ40QA00485300OtherLICENSE #