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Individual

MR. PAUL BRODEUR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PTA

Contact information

Practice address
28 STOUGHTON AVE, WEBSTER, MA 01570-2340
(508) 943-8337
Mailing address
28 STOUGHTON AVE, WEBSTER, MA 01570-2340
(508) 943-8337

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2333
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
161216796
TAX ID
MA
Enumeration date
06/25/2009
Last updated
06/25/2009
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