Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 09801 | OH |
NPI | 1023277233 |
---|---|
Provider Name | Jessica Marie Broz |
First Address | Lakewood, OH 44107-4437 |
Second Address | Westlake, OH 44145-1021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2008 |
Last Update Date | 03/06/2008 |