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General NPI Number Information
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NPI Number | 1114728375
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Entity Type | Individual
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Provider Name | JALYN BRADDOCK
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Gender | Female
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Dates
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Enumeration Date | 03/24/2025
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Last Update Date | 09/18/2025
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Provider Practice Location Address
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Address Line | 1 CHILDRENS PL
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1002
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Country | US
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Telephone | 314-454-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 3915 WILLIAM DR
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City | SAINT CHARLES
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State | MO
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Zip | 63304-6857
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Country | US
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Telephone | 620-203-8397
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2025018253
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License Number State | MO
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