Provider Demographics
NPI:1437522760
Name:BRADDOCK, SARAH (DPT)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:BRADDOCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13937 S SPRAGUE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-7864
Mailing Address - Country:US
Mailing Address - Phone:385-308-8034
Mailing Address - Fax:
Practice Address - Street 1:13937 S SPRAGUE LN STE 100
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-7864
Practice Address - Country:US
Practice Address - Phone:385-308-8034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-09
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.027407225100000X
ALPTH11361225100000X
NJ40QA02178100225100000X
NY050124225100000X
MA26903225100000X
KS11-07227225100000X
MI5501302776225100000X
CA304693225100000X
OHPT020729225100000X
FLPT 30736225100000X
PAPT031244225100000X
TX1372133225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIJ769ZMedicare PIN