Individual
BREANNA BRACERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4729 STAMM LN UNIT 5, NAMPA, ID 83687-5761
(307) 760-1264
Mailing address
899 STATE HIGHWAY 230, LARAMIE, WY 82070-8508
(307) 760-1264
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
0824
WY
225200000X
Physical Therapy Assistant
09433
OR
225200000X
Physical Therapy Assistant
Primary
9155
ID
Other
Enumeration date
01/10/2017
Last updated
03/28/2025
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