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General NPI Number Information
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NPI Number | 1528170669
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Entity Type | Organization
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Legal Business Name | BROBERG PHYSICAL THERAPY
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/16/2007
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Provider Practice Location Address
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Address Line | 6055 MERIDIAN AVE SUITE 110
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City | SAN JOSE
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State | CA
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Zip | 95120
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Country | US
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Telephone | 408-927-0871
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Fax | 408-927-0891
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Provider Business Mailing Address
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Address Line | 6055 MERIDIAN AVE SUITE 110
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City | SAN JOSE
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State | CA
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Zip | 95120
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Country | US
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Telephone | 408-927-0871
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Fax | 408-927-0891
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Authorized Official
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Title or Position | OWNER-PHYSICAL THERAPIST
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Name | MR. WAYNE A BROBERG
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Credential | MPT
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Telephone | 408-927-0871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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