Provider Demographics
NPI:1609249051
Name:SCHAIDT, BRADEN NELSON (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BRADEN
Middle Name:NELSON
Last Name:SCHAIDT
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24640 JASMINE CT
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-4120
Mailing Address - Country:US
Mailing Address - Phone:951-836-1098
Mailing Address - Fax:
Practice Address - Street 1:3989 W STETSON AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545
Practice Address - Country:US
Practice Address - Phone:951-652-3334
Practice Address - Fax:951-652-3335
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43368225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA181091Medicare PIN
CACA181090Medicare PIN
CACB247330Medicare PIN
CACA181092Medicare PIN