Provider Demographics
NPI:1346357316
Name:BRADEN, HEATHER J (PT, MPT, PHD, GCS)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:J
Last Name:BRADEN
Suffix:
Gender:F
Credentials:PT, MPT, PHD, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ASU STA # 10923
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76909-0001
Mailing Address - Country:US
Mailing Address - Phone:325-942-2581
Mailing Address - Fax:
Practice Address - Street 1:ASU STA # 10923
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76909-0001
Practice Address - Country:US
Practice Address - Phone:325-942-2581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1135101225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist