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Individual
MR. WAYNE J BROADT
Active
Individual
MR. WAYNE J BROADT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1177760
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0046NN
BCBS
TX
01
—
00994Z
MEDICARE PART B
TX
05
—
178709501
—
TX
01
—
676617
MEDICARE PART A
TX
Enumeration date
02/18/2009
Last updated
08/04/2016
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