Individual
SANDY BROGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4161 TAMIAMI TRAIL, UNIT 704, PORT CHARLOTTE, FL 33952-9283
(941) 625-1110
Mailing address
4161 TAMIAMI TRL STE 704, PORT CHARLOTTE, FL 33952-9283
(941) 625-1110
Taxonomy
Speciality
Code
Description
License number
State
261QR0401X
Comprehensive Outpatient Rehabilitation Facility (CORF)
Primary
PTA29316
FL
Other
Enumeration date
10/23/2019
Last updated
10/23/2019
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