Individual
THERESE LISIEUX BRODERICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
391 W LAWRENCE ST, ALBANY, NY 12208-2135
(518) 482-2639
(518) 482-2639
Mailing address
391 W LAWRENCE ST, ALBANY, NY 12208-2135
(518) 482-2639
(518) 482-2639
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/15/2019
Last updated
07/15/2019
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