Provider Demographics
NPI:1013682947
Name:STRUBLE, BRADEN H (PTA)
Entity Type:Individual
Prefix:
First Name:BRADEN
Middle Name:H
Last Name:STRUBLE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
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Mailing Address - Street 1:200 W DOUGLAS AVE STE 1040
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3017
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:316-263-1241
Practice Address - Street 1:513 E 16TH ST
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:KS
Practice Address - Zip Code:67152-2802
Practice Address - Country:US
Practice Address - Phone:620-968-3134
Practice Address - Fax:620-968-3135
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS14-03891225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant