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General NPI Number Information
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NPI Number | 1609558246
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Entity Type | Individual
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Provider Name | RANDAL BRYCE BRASWELL
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Gender | Male
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 3411 S DALE MABRY HWY
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City | TAMPA
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State | FL
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Zip | 33629-8658
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Country | US
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Telephone | 813-742-9501
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Fax |
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Provider Business Mailing Address
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Address Line | 6208 SANDERS DR
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City | TAMPA
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State | FL
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Zip | 33611-5012
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Country | US
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Telephone | 704-320-8425
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | P22492
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License Number State | NC
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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 | PT43013
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License Number State | FL
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