Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2305211422 | PA |
NPI | 1003382334 |
---|---|
Provider Name | Doriean Broady |
First Address | Philadelphia, PA 19139-2727 |
Second Address | Philadelphia, PA 19139-2727 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2018 |
Last Update Date | 14/10/2018 |