Healthcare Provider Details

I. General information

NPI: 1104759489
Provider Name (Legal Business Name): BRAEDEN L KNUTSON DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 BUTLER SPAETH RD
GILLETTE WY
82718-5483
US

IV. Provider business mailing address

717 EXPRESS DR APT 526
GILLETTE WY
82718-4136
US

V. Phone/Fax

Practice location:
  • Phone: 307-686-8177
  • Fax: 307-686-9484
Mailing address:
  • Phone: 701-680-8902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2621
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: