Healthcare Provider Details

I. General information

NPI: 1598670754
Provider Name (Legal Business Name): KAITLIN BRASWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 5TH AVE STE 101B
INDIATLANTIC FL
32903
US

IV. Provider business mailing address

783 GLENGARRY DR
MELBOURNE FL
32940-1867
US

V. Phone/Fax

Practice location:
  • Phone: 321-372-3090
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT45222
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: