Provider Demographics
NPI:1447645494
Name:BRAUCH, CASSANDRA ELIZABETH (PTA)
Entity type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:ELIZABETH
Last Name:BRAUCH
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 1:1120 ST. PAUL ST. GROUND LEVEL
Mailing Address - Street 2:ST. PAUL & BIDDLE MEDICAL ASSOCIATES
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-2685
Mailing Address - Country:US
Mailing Address - Phone:410-685-7790
Mailing Address - Fax:410-682-7851
Practice Address - Street 1:5428 B SINCLAIR LANE
Practice Address - Street 2:NORTHEAST DIVISION
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21206-4645
Practice Address - Country:US
Practice Address - Phone:410-488-3800
Practice Address - Fax:410-488-8424
Is Sole Proprietor?:No
Enumeration Date:2015-04-06
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA2517225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant