MEDICARE: SUSAN BRADDOCK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1528635141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN BRADDOCK

Provider Business Mailing Address
First Line	:	2009 TREMONT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-3959
Country	:	US
Telephone Number	:	817-395-6284
Fax Number	:	817-423-7734

Provider Business Practice Location Address
First Line	:	2009 TREMONT AVE
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76107-3959
Country	:	US
Telephone Number	:	817-395-6284
Fax Number	:	817-423-7734

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2021
Last Update Date	:	06/10/2021

Similar Medicare Providers

1730731688 — BEBD TELEHEALTH
Practice Location Address:

2009 TREMONT AVE
FORT WORTH, TX
76107-3959

Practice Phone: 817-437-3077
Practice Fax:

1861153785 — BRIDGESIDE TELEHEALTH
Practice Location Address:

2009 TREMONT AVE
FORT WORTH, TX
76107-3959

Practice Phone: 817-395-6284
Practice Fax:

1306528666 — JEANNE BRIDGET FLYNN
Practice Location Address:

3959 VIA POINCIANA APT 101
LAKE WORTH, FL
33467-2936

Practice Phone: 401-447-0724
Practice Fax:

1497721666 — MS. JULIE K GREEN P.A.
Practice Location Address:

1107 S LEMAY AVE STE 200
FORT COLLINS, CO
80524-3959

Practice Phone: 970-449-0315
Practice Fax: 970-823-7007

1275698904 — LARA M ANTONELLI PA
Practice Location Address:

1107 S LEMAY AVE STE 200
FORT COLLINS, CO
80524-3959

Practice Phone: 970-484-1757
Practice Fax: 970-484-9924

1841434073 — DR. MARK ANDREW SCOTT D.C.
Practice Location Address:

5125 S COLLEGE AVE , SUITE A
FORT COLLINS, CO
80525-3959

Practice Phone: 970-482-1175
Practice Fax: 970-372-6459

Directions to “ SUSAN BRADDOCK ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.