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NPI Code Detail

MEDICARE: JESSICA BROBST DPT

MEDICARE: JESSICA BROBST DPT
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
1225100000XPhysical Therapist5501303035MI

General Provider Information

NPI Number : 1518893437
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA BROBST DPT
Provider Business Mailing Address
First Line : 39115 LYNDON ST
Second Line :
City : LIVONIA
State : MI
Zip : 48154-4714
Country : US
Telephone Number : 419-270-2652
Fax Number :
Provider Business Practice Location Address
First Line : 36475 FIVE MILE RD
Second Line :
City : LIVONIA
State : MI
Zip : 48154-1971
Country : US
Telephone Number : 734-655-2816
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2026
Last Update Date : 06/18/2026

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Directions to “ JESSICA BROBST DPT” Practice Location

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