Individual
MR. EDWARD RICHARD BROAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1152490
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021MG
BCBS GRP
—
01
—
8T3999
BCBS IND
—
01
—
DD3715
MEDICARE RAILROAD GRP
—
01
—
P00223957
MEDICARE RAILROAD IND
—
Enumeration date
07/25/2006
Last updated
01/13/2026
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