Healthcare Provider Details

I. General information

NPI: 1033662788
Provider Name (Legal Business Name): BRADEN HURST DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PIEDMONT AVE
CINCINNATI OH
45219-4231
US

IV. Provider business mailing address

222 PIEDMONT AVE
CINCINNATI OH
45219-4231
US

V. Phone/Fax

Practice location:
  • Phone: 513-621-7777
  • Fax:
Mailing address:
  • Phone: 502-510-2975
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006895
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberCPO18924T
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: