Staci A Braden, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1148280 Issued in TX

Practice address

2421 Ira E Woods Ave
Suite 101
Grapevine, TX 76051-3906

Phone

(817) 410-7773

Fax

(817) 421-5440

NPI assigned

Dec 19, 2006

Last updated

Nov 16, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Restoration Health LPGroup PAC ID 9234308677, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Restoration Health LP

  • Physical Therapist
  • Grapevine, TX
  • NPI 1558441493
  Medicare reassignment Care Compare group

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1289865600000",
    "number": "1073676102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10024 CADE TRL",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762486648",
            "telephone_number": "682-551-9244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2421 IRA E WOODS AVE",
            "address_2": "SUITE 101",
            "city": "GRAPEVINE",
            "state": "TX",
            "postal_code": "760513906",
            "telephone_number": "817-410-7773",
            "fax_number": "817-421-5440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADEN",
        "first_name": "STACI",
        "middle_name": "A",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-19",
        "last_updated": "2010-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1148280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER #",
            "identifier": "8T7054",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "1148280",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jason Bonisolli
• Laura L Bonner, CRNFA
• Rawn Edward Bosley, M.D.
• Dianne Bowers, F.N.P.-BC
• Nadine Bracy, M.A., LPC
• Brennan Riche D.C.
• Lisa Brennan, LPC
• Brent W. Bost, MD, PA (Brent W. Bost)
• Arika Bright, RBT
• Michael Ryan Briseno, M.D.

• Physical Therapist in Grapevine, TX
• Providers in Grapevine, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.