Individual
LISA BRACHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MBA, LAT, ATC
Contact information
Practice address
3601 S CALHOUN ST, FORT WAYNE, IN 46807-2006
(260) 467-2653
Mailing address
1518 TECUMSEH ST, FORT WAYNE, IN 46805-4248
(260) 409-8862
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
36002654A
IN
Other
Enumeration date
11/06/2017
Last updated
11/06/2017
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