Individual
MATT BROKAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
300 TENNEY ST, KEWANEE, IL 61443-3452
(309) 853-5500
Mailing address
135 N WILLIAMSBURG DR, BLOOMINGTON, IL 61704-3528
(309) 661-8823
(309) 661-8801
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160002429
IL
Other
Enumeration date
06/12/2012
Last updated
06/12/2012
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