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NPI Code Detail

MEDICARE: BRADEN GAGE JACKSON

MEDICARE: BRADEN GAGE JACKSON
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
1225100000XPhysical Therapist009273KY

General Provider Information

NPI Number : 1124830419
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADEN GAGE JACKSON
Provider Business Mailing Address
First Line : 1200 CORPORATE DR STE 400
Second Line :
City : HOOVER
State : AL
Zip : 35242-5424
Country : US
Telephone Number : 423-238-7217
Fax Number :
Provider Business Practice Location Address
First Line : 1010 MONARCH ST STE 150
Second Line :
City : LEXINGTON
State : KY
Zip : 40513-1892
Country : US
Telephone Number : 859-219-0211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/23/2025
Last Update Date : 02/05/2025

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Directions to “ BRADEN GAGE JACKSON ” Practice Location

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