Provider Demographics
NPI:1609839034
Name:BRADEN, KAREN ELISE (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELISE
Last Name:BRADEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 FRANKLIN RD STE 135A-102
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-3280
Mailing Address - Country:US
Mailing Address - Phone:509-249-5860
Mailing Address - Fax:
Practice Address - Street 1:1608 S 24TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-5719
Practice Address - Country:US
Practice Address - Phone:509-248-6113
Practice Address - Fax:509-457-8941
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB03267Medicare ID - Type Unspecified
WA8343717Medicaid
WA147246OtherL & I