Individual
MS. BIANCA SIMONE BROUGHTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LAT, ATC, EMT
Contact information
Practice address
2355 DUNCANVILLE RD, DALLAS, TX 75211-6532
(281) 772-2210
Mailing address
2500 WARREN CARROLL DR, RALEIGH, NC 27695
(919) 515-2111
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
2481
NC
2255A2300X
Athletic Trainer
Primary
AT5277
TX
Other
Enumeration date
03/12/2015
Last updated
12/08/2022
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