Individual
BYRON BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1921 W IRVING PARK RD, CHICAGO, IL 60613-2407
(773) 687-9442
Mailing address
1921 W IRVING PARK RD, CHICAGO, IL 60613-2407
(773) 687-9442
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.008003
IL
Other
Enumeration date
01/07/2018
Last updated
01/16/2019
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