Individual
BRODERICK EARL PEARISO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
3370 E JOLLY RD, LANSING, MI 48910-8552
(517) 332-7246
(517) 332-1474
Mailing address
3370 E JOLLY RD, LANSING, MI 48910-8552
(517) 332-7246
(517) 332-1474
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
5502001428
MI
Other
Enumeration date
07/14/2012
Last updated
07/14/2012
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