Individual
CODY LEE BROOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3261 HIGHWAY 49, COLLINS, MS 39428-3876
(601) 921-6043
(601) 921-6044
Mailing address
599C STEED RD, RIDGELAND, MS 39157-1707
(601) 605-6777
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT7219
MS
Other
Enumeration date
06/22/2022
Last updated
06/22/2022
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