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General NPI Number Information
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NPI Number | 1740433176
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Entity Type | Individual
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Provider Name | JOANNE LYNN BROADWELL PTA
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Gender | Female
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Dates
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Enumeration Date | 10/29/2008
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Last Update Date | 10/30/2008
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Provider Practice Location Address
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Address Line | 140 W 6TH ST SUITE 140
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City | OSWEGO
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State | NY
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Zip | 13126-2525
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Country | US
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Telephone | 315-564-7700
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Fax |
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Provider Business Mailing Address
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Address Line | 140 W 6TH ST SUITE 140
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City | OSWEGO
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State | NY
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Zip | 13126-2525
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Country | US
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Telephone | 315-564-7700
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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 | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 006082-1
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License Number State | NY
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