MEDICARE: KIMBERLY SUZANNE BRODERICK P.T.

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	2251X0800X	Orthopedic Physical Therapist	1-8578-5	TX
2	2255A2300X	Athletic Trainer		TX
3	225100000X	Physical Therapist	1085785	TX

General Provider Information

NPI Number	:	1134264187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY SUZANNE BRODERICK P.T.

Provider Business Mailing Address
First Line	:	8107 LEIGHWOOD CREEK CT
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77396-3477
Country	:	US
Telephone Number	:	281-458-5390
Fax Number	:

Provider Business Practice Location Address
First Line	:	7840 FM 1960 RD E STE 408409
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77346-2259
Country	:	US
Telephone Number	:	281-812-6665
Fax Number	:	281-812-6869

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	12/24/2020

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Directions to “ KIMBERLY SUZANNE BRODERICK P.T.” Practice Location

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