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General NPI Number Information
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NPI Number | 1629474341
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Entity Type | Individual
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Provider Name | ALYSIA BRADDOCK
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Gender | Female
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 9441 LBJ FWY SUITE 602
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City | DALLAS
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State | TX
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Zip | 75243-4545
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Country | US
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Telephone | 469-249-1882
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Fax | 877-788-7505
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Provider Business Mailing Address
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Address Line | 9441 LBJ FWY SUITE 602
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City | DALLAS
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State | TX
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Zip | 75243-4545
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Country | US
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Telephone | 469-249-1882
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Fax | 877-788-7505
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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 | 227900000X
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Taxonomy Name | Registered Respiratory Therapist
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License Number | LR60273231
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License Number State | WA
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