Provider Demographics
NPI:1720504392
Name:BRANAUM, CLAIRE ELLEN (PT)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:ELLEN
Last Name:BRANAUM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4602 CUMBERLAND RD # RE
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-2412
Mailing Address - Country:US
Mailing Address - Phone:910-423-5622
Mailing Address - Fax:
Practice Address - Street 1:4602 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-2412
Practice Address - Country:US
Practice Address - Phone:910-423-5622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-16
Last Update Date:2018-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18139225100000X
KS11-05758225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist