Healthcare Provider Details

I. General information

NPI: 1154088649
Provider Name (Legal Business Name): BRADEN JOSEPH JOHNSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 CHESTNUT STATION CT
LOUISVILLE KY
40299-6395
US

IV. Provider business mailing address

4030 TATES CREEK RD APT 1000
LEXINGTON KY
40517-3074
US

V. Phone/Fax

Practice location:
  • Phone: 800-335-1060
  • Fax:
Mailing address:
  • Phone: 502-759-4020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number008453
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: