Healthcare Provider Details

I. General information

NPI: 1902678626
Provider Name (Legal Business Name): BRADEN CHRISTOPHER URBAN PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2023
Last Update Date: 10/25/2023
Certification Date: 10/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 E HWY 50 STE 101
CLERMONT FL
34711-5107
US

IV. Provider business mailing address

16730 WOODBERRY WAY
CLERMONT FL
34714-5811
US

V. Phone/Fax

Practice location:
  • Phone: 407-818-2406
  • Fax:
Mailing address:
  • Phone: 937-269-8549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT39737
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: