Provider Demographics
NPI:1033792940
Name:CRADER, BRENDAN ROBERT
Entity Type:Individual
Prefix:
First Name:BRENDAN
Middle Name:ROBERT
Last Name:CRADER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 OSAGE DR
Mailing Address - Street 2:
Mailing Address - City:ADVANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63730-8062
Mailing Address - Country:US
Mailing Address - Phone:573-321-0942
Mailing Address - Fax:
Practice Address - Street 1:913 W BUSINESS US HIGHWAY 60
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-2704
Practice Address - Country:US
Practice Address - Phone:573-624-6405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty