Provider Demographics
NPI:1902552110
Name:BRAUTIGAM, JUSTIN ROBERT (PT, DPT, ATC)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:ROBERT
Last Name:BRAUTIGAM
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LEGEND LANE
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9424
Mailing Address - Country:US
Mailing Address - Phone:717-620-7100
Mailing Address - Fax:717-620-7102
Practice Address - Street 1:1 LEGEND LANE
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9424
Practice Address - Country:US
Practice Address - Phone:717-620-7100
Practice Address - Fax:717-620-7102
Is Sole Proprietor?:No
Enumeration Date:2022-02-25
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT030267225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist