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General NPI Number Information
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NPI Number | 1134264187
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Entity Type | Individual
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Provider Name | KIMBERLY SUZANNE BRODERICK P.T.
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Gender | Female
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 12/24/2020
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Provider Practice Location Address
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Address Line | 7840 FM 1960 RD E STE 408409
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City | HUMBLE
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State | TX
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Zip | 77346-2259
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Country | US
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Telephone | 281-812-6665
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Fax | 281-812-6869
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Provider Business Mailing Address
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Address Line | 8107 LEIGHWOOD CREEK CT
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City | HUMBLE
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State | TX
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Zip | 77396-3477
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Country | US
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Telephone | 281-458-5390
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 1-8578-5
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1085785
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License Number State | TX
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