Individual
LENITA D BROUSSARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1620 MAGNOLIA ST, LIBERTY, TX 77575-3546
(936) 336-8844
Mailing address
2455 MONTGOMERY RD APT 14, HUNTSVILLE, TX 77340-5903
(979) 383-4905
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2157497
TX
Other
Enumeration date
09/22/2020
Last updated
09/22/2020
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