Provider Demographics
NPI:1790576965
Name:SEBOE, BRADEN
Entity type:Individual
Prefix:
First Name:BRADEN
Middle Name:
Last Name:SEBOE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11725 S SHANNAN ST APT 815
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-3753
Mailing Address - Country:US
Mailing Address - Phone:570-892-2549
Mailing Address - Fax:
Practice Address - Street 1:1401 BAPTISTE DR STE 200
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1889
Practice Address - Country:US
Practice Address - Phone:913-632-4732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist