1144774456 NPI number — BRAIDY SCOTT SOLIE PT, DPT, CSCS

Table of content: BRAIDY SCOTT SOLIE PT, DPT, CSCS (NPI 1144774456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144774456 NPI number — BRAIDY SCOTT SOLIE PT, DPT, CSCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOLIE
Provider First Name:
BRAIDY
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT, CSCS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144774456
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4200 DAHLBERG DR STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GOLDEN VALLEY
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55422-4841
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-512-5600
Provider Business Mailing Address Fax Number:
952-512-5651

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1440 DUCKWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAGAN
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55122-1451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-808-3000
Provider Business Practice Location Address Fax Number:
952-808-3001
Provider Enumeration Date:
08/04/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  10333 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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