Individual
CARISSA M BROUGHMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPTA
Contact information
Practice address
2901 SELMA- LOW MOOR RD, LOW MOOR, VA 24457-9998
(540) 862-0068
Mailing address
2901 SELMA LOW MOOR RD, LOW MOOR, VA 24457
(540) 862-0068
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2306603866
VA
Other
Enumeration date
04/08/2019
Last updated
04/08/2019
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