Individual
MR. TERRANCE BROUSSARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12672 FEDERAL PL, FISHERS, IN 46037-7833
(317) 374-4102
Mailing address
12672 FEDERAL PL, FISHERS, IN 46037-7833
(317) 374-4102
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
991572
IN
Other
Enumeration date
11/14/2014
Last updated
11/14/2014
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