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General NPI Number Information
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NPI Number | 1538308390
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Entity Type | Individual
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Provider Name | WAYNE J BROADT PT
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Gender | Male
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Dates
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Enumeration Date | 02/18/2009
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 920 S CLOSNER BLVD SUITE: B
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City | EDINBURG
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State | TX
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Zip | 78539-5617
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Country | US
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Telephone | 956-287-2006
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Fax | 956-287-2016
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Provider Business Mailing Address
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Address Line | 920 S CLOSNER BLVD SUITE: B
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City | EDINBURG
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State | TX
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Zip | 78539-5617
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Country | US
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Telephone | 956-287-2006
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Fax | 956-287-2016
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1177760
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License Number State | TX
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