Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | OI00000090 | WA |
Y | 222Z00000X | Podiatrist | OI00000090 | WA |
N | 224P00000X | Prosthetist | PS00000089 | WA |
NPI | 1265759120 |
---|---|
Provider Name | Thomas Broselle |
First Address | Everett, WA 98203-2200 |
Second Address | Bellingham, WA 98225-5241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2010 |
Last Update Date | 03/05/2010 |