Individual
ELLIOT DUANE BROADHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
527 5TH AVE #500, SHEPPARD AFB, TX 76311
(208) 828-4626
Mailing address
1410 W AIRBASE RD APT 2, MOUNTAIN HOME, ID 83647-3344
(208) 730-7467
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
5817
ID
Other
Enumeration date
05/02/2019
Last updated
09/18/2023
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