Individual
MISS SANDRA KATHRYN BROKAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
708 S JEFFERSON WAY, INDIANOLA, IA 50125-3216
(515) 962-2555
Mailing address
2225 GRAND AVE APT 104, DES MOINES, IA 50312-5316
(515) 991-4261
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
004802
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004802
STATE OF IOWA
IA
Enumeration date
09/26/2012
Last updated
09/26/2012
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