Provider Demographics
NPI:1548345978
Name:BRACKEN, ELIZABETH ALAINA WINN (PT, MS, CMIT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ALAINA WINN
Last Name:BRACKEN
Suffix:
Gender:F
Credentials:PT, MS, CMIT
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Mailing Address - Street 1:8221 OLD COURTHOUSE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3839
Mailing Address - Country:US
Mailing Address - Phone:571-207-6557
Mailing Address - Fax:
Practice Address - Street 1:8221 OLD COURTHOUSE RD STE 200
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3839
Practice Address - Country:US
Practice Address - Phone:937-681-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA2305204853261QP2000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy