Provider Demographics
NPI:1700907938
Name:BRADDOCK PHYSICAL THERAPY & REHABILITATION, INC.
Entity Type:Organization
Organization Name:BRADDOCK PHYSICAL THERAPY & REHABILITATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ROY
Authorized Official - Last Name:BRADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:724-846-5887
Mailing Address - Street 1:1008 7TH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-4558
Mailing Address - Country:US
Mailing Address - Phone:724-846-5887
Mailing Address - Fax:724-436-7200
Practice Address - Street 1:1008 7TH AVE STE 205
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010
Practice Address - Country:US
Practice Address - Phone:724-846-5887
Practice Address - Fax:724-436-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001784776OtherHIGHMARK GROUP
OH9351821Medicare ID - Type UnspecifiedGROUP
DE1092Medicare ID - Type UnspecifiedRAILROAD MEDICARE