Provider Demographics
NPI:1871985697
Name:BRADDOCK, LINDSEY (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:
Last Name:BRADDOCK
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 ALAMANCE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298-9113
Mailing Address - Country:US
Mailing Address - Phone:336-207-3877
Mailing Address - Fax:
Practice Address - Street 1:1130 N CHURCH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1038
Practice Address - Country:US
Practice Address - Phone:336-375-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-25072255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer