| NPI | 1679898522 |
|---|---|
| Former Name | MICHELLE BRODERSEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 3893) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: CT 3893) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: CT 3893) | |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2010-04-05 |