Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | 11-02793 | KS |
N | 2251X0800X | Physical Therapist - Orthopedic | 11-02793 | KS |
NPI | 1194702498 |
---|---|
Provider Name | Mrs. Tiffany C Broeckelman |
First Address | Overland Park, KS 66204-3161 |
Second Address | Lenexa, KS 66214-1557 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2005 |
Last Update Date | 08/07/2007 |