Provider Demographics
NPI:1619792868
Name:BRASWELL, KYANDRA (PT, DPT)
Entity type:Individual
Prefix:
First Name:KYANDRA
Middle Name:
Last Name:BRASWELL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 GOLDEN WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:NC
Mailing Address - Zip Code:28551-9205
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 E 5TH ST
Practice Address - Street 2:IRONS BUILDING, OGLESBY DRIVE
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-2502
Practice Address - Country:US
Practice Address - Phone:252-737-1177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-21
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist