Provider Demographics
NPI:1285844068
Name:STEFFY, BRADEN (PT)
Entity Type:Individual
Prefix:MR
First Name:BRADEN
Middle Name:
Last Name:STEFFY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:266 EAGLEVIEW BLVD
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-1157
Practice Address - Country:US
Practice Address - Phone:610-524-1019
Practice Address - Fax:610-524-4125
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1996644OtherPABS
1285844068OtherCHAMPUS TRICARE
5070-0061OtherCARE FIRST
88760517OtherCARE FIRST
11779640OtherCAQH
DE1285844068Medicaid
PA2856802000OtherAMERICHOICE/IBC
11779640OtherCAQH
DE003453A78Medicare PIN
PA2856802000OtherAMERICHOICE/IBC