Provider Demographics
NPI:1750562138
Name:BRASFIELD, EARL BRADEN (MSPT, OCS)
Entity type:Individual
Prefix:MR
First Name:EARL
Middle Name:BRADEN
Last Name:BRASFIELD
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Gender:M
Credentials:MSPT, OCS
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Mailing Address - Street 1:2716 TELEGRAPH RD
Mailing Address - Street 2:SUITE #107
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-4078
Mailing Address - Country:US
Mailing Address - Phone:314-894-9008
Mailing Address - Fax:314-894-1232
Practice Address - Street 1:2716 TELEGRAPH RD
Practice Address - Street 2:SUITE #107
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4078
Practice Address - Country:US
Practice Address - Phone:314-894-9008
Practice Address - Fax:314-894-1232
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
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Provider Licenses
StateLicense IDTaxonomies
MO118376225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO488363201Medicaid
MO000021757Medicare UPIN