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General NPI Number Information
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NPI Number | 1932177680
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Entity Type | Individual
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Provider Name | SANDRA KAY BROUGHER PTA
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Gender | Female
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5114 BALCONES WOODS DR #306
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City | AUSTIN
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State | TX
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Zip | 78759
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Country | US
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Telephone | 512-794-8863
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Fax | 512-795-0688
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Provider Business Mailing Address
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Address Line | 4005 ETON LN
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City | AUSTIN
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State | TX
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Zip | 78727
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Country | US
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Telephone | 512-821-9935
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Fax | 512-795-0688
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 207738
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License Number State | TX
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