Individual
MICHELLE BRODEUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
106 CT 66, COLUMBIA, CT 06237-0623
(860) 228-0194
Mailing address
106 CT 66, COLUMBIA, CT 06237
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT30108
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IB763Z
MEDICARE PTAN
FL
01
—
Y0Q7S
BLUE CROSS BLUE SHIELD
FL
Enumeration date
02/17/2015
Last updated
04/14/2021
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