Braeden Lee Clement

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1385132 Issued in TX

Practice address

6530 W Loop 1604 N
San Antonio, TX 78254-6319

Phone

(210) 476-5577

NPI assigned

Jan 27, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Revival Performance Physical TherapyGroup PAC ID 0941606784, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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

• Revival Performance Physical Therapy

  • Physical Therapy Clinic/Center
  • San Antonio, TX
  • NPI 1184298424

  Physical Therapist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1674777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702252800000",
    "number": "1336855808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6404 ASPEN HL",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782385401",
            "telephone_number": "435-531-0821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6530 W LOOP 1604 N",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782546319",
            "telephone_number": "210-476-5577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLEMENT",
        "first_name": "BRAEDEN",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-01-27",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "TX",
            "license": "1385132",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1385132",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Autumn Dawn Clegg, OTR, CBIS
• Catherine Michelle Clegg, LCSW
• Rea Marouf Cleland, MD, MS
• Timothy Paul Cleland, M.D.
• Elliott Irving Clemence III, MD
• Britton Clement
• John P. Clement IV, M.D., PH.D.
• Kathryn A Clement, FNP-C
• Michele Clements-Thompson, PH.D.
• Charles Wes Clements III, M.D.

• Physical Therapist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; 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.