MEDICARE: BRAEDEN L KNUTSON DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT-2621	WY

General Provider Information

NPI Number	:	1104759489
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRAEDEN L KNUTSON DPT

Provider Business Mailing Address
First Line	:	717 EXPRESS DR APT 526
Second Line	:
City	:	GILLETTE
State	:	WY
Zip	:	82718-4136
Country	:	US
Telephone Number	:	701-680-8902
Fax Number	:

Provider Business Practice Location Address
First Line	:	3251 BUTLER SPAETH RD
Second Line	:
City	:	GILLETTE
State	:	WY
Zip	:	82718-5483
Country	:	US
Telephone Number	:	307-686-8177
Fax Number	:	307-686-9484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2026
Last Update Date	:	06/05/2026

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Directions to “ BRAEDEN L KNUTSON DPT” Practice Location

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