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NPI Code Detail

MEDICARE: JILLIAN BRODERICK PTA

MEDICARE: JILLIAN BRODERICK PTA
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
1225200000XPhysical Therapy Assistant7896MA

General Provider Information

NPI Number : 1285079814
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILLIAN BRODERICK PTA
Provider Business Mailing Address
First Line : 4 JACOBS AVE
Second Line :
City : BEVERLY
State : MA
Zip : 01915-4126
Country : US
Telephone Number : 978-922-9239
Fax Number :
Provider Business Practice Location Address
First Line : 7 RESERVOIR RD
Second Line :
City : BEVERLY
State : MA
Zip : 01915-5501
Country : US
Telephone Number : 978-524-0333
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2013
Last Update Date : 05/09/2013

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