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General NPI Number Information
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NPI Number | 1336855808
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Entity Type | Individual
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Provider Name | BRAEDEN LEE CLEMENT
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Gender | Male
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Dates
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Enumeration Date | 01/27/2023
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 6530 W LOOP 1604 N
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City | SAN ANTONIO
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State | TX
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Zip | 78254-6319
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Country | US
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Telephone | 210-476-5577
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Fax |
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Provider Business Mailing Address
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Address Line | 6404 ASPEN HL
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City | SAN ANTONIO
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State | TX
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Zip | 78238-5401
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Country | US
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Telephone | 435-531-0821
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1385132
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1385132
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License Number State | TX
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