Healthcare Provider Details

I. General information

NPI: 1114850807
Provider Name (Legal Business Name): BRAYDEN M MATEUSZCZYK PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 FRANCE AVE S STE 260
EDINA MN
55435-1816
US

IV. Provider business mailing address

6247 MACLYNN AVE NE
OTSEGO MN
55301-4527
US

V. Phone/Fax

Practice location:
  • Phone: 952-922-0330
  • Fax:
Mailing address:
  • Phone: 508-530-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14393
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: