MEDICARE: JESSICA MARIE BROZ P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	09801	OH

General Provider Information

NPI Number	:	1023277233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA MARIE BROZ P.T.

Provider Business Mailing Address
First Line	:	1580 LINCOLN AVE
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-4437
Country	:	US
Telephone Number	:	440-570-1457
Fax Number	:

Provider Business Practice Location Address
First Line	:	30033 CLEMENS RD
Second Line	:
City	:	WESTLAKE
State	:	OH
Zip	:	44145-1021
Country	:	US
Telephone Number	:	440-899-5625
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2008
Last Update Date	:	06/03/2008

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