Provider Demographics
NPI:1750833828
Name:STARR, BRAYDEN (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:BRAYDEN
Middle Name:
Last Name:STARR
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 N BELSAY RD
Mailing Address - Street 2:
Mailing Address - City:BURTON
Mailing Address - State:MI
Mailing Address - Zip Code:48509-1602
Mailing Address - Country:US
Mailing Address - Phone:810-250-6112
Mailing Address - Fax:810-250-6113
Practice Address - Street 1:1365 N BELSAY RD
Practice Address - Street 2:
Practice Address - City:BURTON
Practice Address - State:MI
Practice Address - Zip Code:48509-1602
Practice Address - Country:US
Practice Address - Phone:102-506-1128
Practice Address - Fax:810-250-6113
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010017942255A2300X
MI5501019871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer