Healthcare Provider Details

I. General information

NPI: 1780244863
Provider Name (Legal Business Name): DANIEL BRASWELL PT, DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 CENTRAL AVE
EIELSON AFB AK
99702-2301
US

IV. Provider business mailing address

4076 NEELY RD.
FORT WAINWRIGHT AK
99703
US

V. Phone/Fax

Practice location:
  • Phone: 73-771-8479
  • Fax:
Mailing address:
  • Phone: 73-771-8479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number147360
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: