Provider Demographics
NPI:1174051361
Name:HYNEK, BRADEN JOHN (DPT)
Entity type:Individual
Prefix:
First Name:BRADEN
Middle Name:JOHN
Last Name:HYNEK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 HUNTER PL APT 104
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503-8022
Mailing Address - Country:US
Mailing Address - Phone:785-410-2989
Mailing Address - Fax:
Practice Address - Street 1:4201B ANDERSON AVE STE 1
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7601
Practice Address - Country:US
Practice Address - Phone:785-539-5555
Practice Address - Fax:785-539-4551
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-05596225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201160630AMedicaid