Individual
JUSTIN MILES BROUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
100 N UNIVERSITY DR, EDMOND, OK 73034-5207
(405) 471-1174
Mailing address
705 LITTLE RIVER CIR, MOORE, OK 73160-2500
(405) 471-1174
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
774
OK
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/13/2020
Last updated
01/13/2020
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