Individual
MADONNA MARIE BROQUET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3516 WAUKEGAN RD, MCHENRY, IL 60050-5732
(815) 271-5249
Mailing address
PO BOX 369, LAKE VILLA, IL 60046-0369
(847) 421-2148
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
1441-19
WI
225200000X
Physical Therapy Assistant
Primary
160.001738
IL
Other
Enumeration date
08/24/2011
Last updated
08/24/2011
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