Individual
MISS CORI DIANE BROEDLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MT, PTA
Contact information
Practice address
3033 SARNO RD, MELBOURNE, FL 32934-7229
(321) 610-8979
(321) 610-8980
Mailing address
5065 MALABAR BLVD, MELBOURNE BEACH, FL 32951-3257
(720) 635-4127
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
MT0008418
CO
225200000X
Physical Therapy Assistant
Primary
PTA25013
FL
Other
Enumeration date
09/19/2013
Last updated
01/10/2017
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