Healthcare Provider Details

I. General information

NPI: 1093835449
Provider Name (Legal Business Name): CINDY LEE BROOMS LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16600 DANVILLE PIKE
LAUREL FORK VA
24352-3804
US

IV. Provider business mailing address

1123 N MAIN ST
HILLSVILLE VA
24343-1132
US

V. Phone/Fax

Practice location:
  • Phone: 276-398-2117
  • Fax:
Mailing address:
  • Phone: 276-728-2797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306000640
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: