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Individual

ZACHARY BRADDOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT, DPT

Contact information

Practice address
1109 W MYRTLE ST, SUITE 200, BOISE, ID 83702-6970
(208) 489-4331
Mailing address
6578 N SPURWING WAY, MERIDIAN, ID 83646-6454

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-4501
ID

Other

Enumeration date
07/18/2016
Last updated
07/18/2016
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