Individual
DEBRA LYNN BRODERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2410 W PLAZA DR, TALLAHASSEE, FL 32308-5325
(850) 385-6185
(850) 385-2580
Mailing address
4099 SPAIN FERRY RD, VALDOSTA, GA 31601-9119
(229) 561-4767
(229) 890-3397
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
PTA003216
GA
225200000X
Physical Therapy Assistant
Primary
PTA32057
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PTA003216
PHYSICAL THERAPY ASSISTANT
GA
01
—
PTA32057
FLORIDA BOARD OF PHYSICAL THERAPY
FL
Enumeration date
02/05/2014
Last updated
06/28/2022
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