Healthcare Provider Details

I. General information

NPI: 1013583475
Provider Name (Legal Business Name): IAN TYGAR BRADEN DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2021
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 JUNO OCEAN WALK STE 504C
JUNO BEACH FL
33408-1121
US

IV. Provider business mailing address

9331 SE DUNCAN ST
HOBE SOUND FL
33455-6909
US

V. Phone/Fax

Practice location:
  • Phone: 561-627-2525
  • Fax:
Mailing address:
  • Phone: 561-512-4707
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: