Individual
THADDEUS BRODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8102 ENGLEWOOD RD, INDIANAPOLIS, IN 46240-2749
(317) 473-7489
Mailing address
8102 ENGLEWOOD RD, INDIANAPOLIS, IN 46240-2749
(317) 473-7489
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
76141
IN
390200000X
Student in an Organized Health Care Education/Training Program
Primary
76141
IN
Other
Enumeration date
02/23/2015
Last updated
02/23/2015
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