Healthcare Provider Details

I. General information

NPI: 1144260563
Provider Name (Legal Business Name): WILLIAM NELSON BROSKEY P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 07/04/2022
Certification Date: 07/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8725 N WICKHAM RD STE 301
MELBOURNE FL
32940-2240
US

IV. Provider business mailing address

3300 S FISKE BLVD
ROCKLEDGE FL
32955-4306
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-9200
  • Fax:
Mailing address:
  • Phone: 321-434-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT17971
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: