John Keith Braxton, DPT, PTA
Individual provider Active NPI Contractor · Houston, TX
NPI 1629417845 · NPPES record last updated Jun 20, 2013
Key facts
- NPI
- 1629417845
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- License
- 2094020 (TX)
- Practice address
- 17615 Cypress Laurel St
Houston, TX 77095-4777 - Phone
- (832) 563-1578
- NPI assigned
- Jun 20, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2094020 | TX | MD | Contractor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | 2094020 | TX | Yes |
Addresses
Primary practice location
17615 Cypress Laurel St
Houston, TX 77095-4777
Mailing address
17615 Cypress Laurel St
Houston, TX 77095-4777
Phone (832) 563-1578
Other providers in Houston, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.