MEDICARE: MS. PAM BROSKY PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y7802	OTHER	FL	BLUE CROSS BLUE SHIELD PR

General Provider Information

NPI Number	:	1093915183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAM BROSKY PT

Provider Business Mailing Address
First Line	:	3880 COCONUT CREEK PKWY STE 303
Second Line	:
City	:	COCONUT CREEK
State	:	FL
Zip	:	33066-1651
Country	:	US
Telephone Number	:	954-972-9285
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 W HILLSBORO BLVD
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33442-1442
Country	:	US
Telephone Number	:	877-993-2121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	08/02/2019

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