Individual
MR. EDWARD ROY BRADDOCK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
124 LOUGHRIDGE DR, BEAVER FALLS, PA 15010-1422
(724) 846-5887
(724) 843-9276
Mailing address
124 LOUGHRIDGE DR, BEAVER FALLS, PA 15010-1422
(724) 462-5650
(724) 846-1867
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT006762L
PA
225100000X
Physical Therapist
PT010934
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000359936
ANTHEM BC/BS OF OHIO
OH
01
—
1627513
HIGHMARK BC/BS
PA
05
—
2552830
—
OH
01
—
P00272193
RAILROAD MEDICARE
—
Enumeration date
05/17/2006
Last updated
12/07/2017
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