Individual
MR. EDWARD RICHARD BROAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPT
Contact information
Practice address
611 W BROWN ST, #101, WYLIE, TX 75098
(972) 442-5287
(972) 442-3181
Mailing address
1200 CORPORATE DR STE 400, HOOVER, AL 35242-5424
(423) 238-7217
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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