MRS. JENNY M BRADDOCK PT OCS NPI 1558430785

NPI Information

NPI: 1558430785
Provider Name: MRS. JENNY M BRADDOCK, PT, OCS
Classification: Specialist - 174400000X
Entity Type: Individual
Address:
117 SHARON RD
MALL VIEW PLAZA
WATERBURY, CT
ZIP 06705
Phone: (203) 756-2334
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MRS. Jenny M Braddock, PT, OCS is a specialist in Waterbury, CT. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. MRS. Jenny M Braddock, PT, OCS NPI is 1558430785. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

117 SHARON RD
MALL VIEW PLAZA
WATERBURY, CT
ZIP 06705-000
Phone: (203) 756-2334
Fax: (203) 756-2594

The enumeration date for this NPI number is 11/6/2006 and was last updated on 7/9/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		007053	CONNECTICUT	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	080007053CT01	OTHER	CONNECTICUT	BCBS PROVIDER NUMBER
2	076582	MEDICARE ID-TYPE UNSPECIFIED	CONNECTICUT	MEDICARE PROVIDER NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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