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General NPI Number Information
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NPI Number | 1174419006
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Entity Type | Individual
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Provider Name | BRADEN ARCHER BRUNNHOELZL LMT
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Gender | Male
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 12812 OLD GLENN HWY STE A8
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City | EAGLE RIVER
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State | AK
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Zip | 99577-7003
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Country | US
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Telephone | 907-696-8020
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Fax |
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Provider Business Mailing Address
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Address Line | 11231 E AMFAY DR
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City | PALMER
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State | AK
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Zip | 99645-8879
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Country | US
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Telephone | 907-355-2762
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 240459
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License Number State | AK
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