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NPI Code Detail

MEDICARE: YASMIN BROOMAND KHOSHBACHT PT, DPT

MEDICARE: YASMIN BROOMAND KHOSHBACHT PT, 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 TherapistPT31174FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1851747836
Entity Type Code : Individual
Provider Name (Legal Business Name) : YASMIN BROOMAND KHOSHBACHT PT, DPT
Provider Business Mailing Address
First Line : 3901 UNIVERSITY BLVD S
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-4312
Country : US
Telephone Number : 904-345-7336
Fax Number :
Provider Business Practice Location Address
First Line : 500 PARK AVE
Second Line :
City : ORANGE PARK
State : FL
Zip : 32073-3132
Country : US
Telephone Number : 904-278-7890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2016
Last Update Date : 05/10/2016

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