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NPI Code Detail

MEDICARE: JACQUELYN BROERING PT

MEDICARE: JACQUELYN BROERING 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
1225100000XPhysical Therapist11545OH

General Provider Information

NPI Number : 1942383682
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN BROERING PT
Provider Business Mailing Address
First Line : 216 W MAIN ST
Second Line :
City : COLDWATER
State : OH
Zip : 45828-1703
Country : US
Telephone Number : 419-763-1464
Fax Number :
Provider Business Practice Location Address
First Line : 216 W MAIN ST
Second Line :
City : COLDWATER
State : OH
Zip : 45828-1703
Country : US
Telephone Number : 419-763-1464
Fax Number : 419-763-1482
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2006
Last Update Date : 06/08/2022

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Directions to “ JACQUELYN BROERING PT” Practice Location

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