Provider Demographics
NPI:1932230448
Name:BADRY, RICHARD GREGOR (ATC)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:GREGOR
Last Name:BADRY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-2337
Mailing Address - Country:US
Mailing Address - Phone:765-472-3301
Mailing Address - Fax:765-472-5148
Practice Address - Street 1:401 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-1449
Practice Address - Country:US
Practice Address - Phone:765-472-3301
Practice Address - Fax:765-472-5148
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer