Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT026545 | PA |
N | 2251X0800X | Physical Therapist - Orthopedic |
NPI | 1033622535 |
---|---|
Provider Name | Brady Sandercock |
First Address | Plymouth Meeting, PA 19462-1420 |
Second Address | West Chester, PA 19380-6123 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2017 |
Last Update Date | 07/09/2020 |