Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1044 | CO |
NPI | 1003079591 |
---|---|
Provider Name | Norma Brough |
First Address | Monument, CO 80132-8776 |
Second Address | Monument, CO 80132-8776 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2008 |
Last Update Date | 06/07/2008 |