Provider Demographics
NPI:1710214481
Name:BRADEN, COURTNEY SANDRA (LMT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:SANDRA
Last Name:BRADEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 W WATERS AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-2802
Mailing Address - Country:US
Mailing Address - Phone:813-935-8784
Mailing Address - Fax:813-935-8387
Practice Address - Street 1:1412 W WATERS AVE STE 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-2802
Practice Address - Country:US
Practice Address - Phone:813-935-8784
Practice Address - Fax:813-935-8387
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist