MEDICARE: MR. DAVID H BRODER LMT

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	225700000X	Massage Therapist	MA-53347	FL

General Provider Information

NPI Number	:	1952559718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID H BRODER LMT

Provider Business Mailing Address
First Line	:	PO BOX 213293
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33421-3293
Country	:	US
Telephone Number	:	561-793-7879
Fax Number	:

Provider Business Practice Location Address
First Line	:	4935 OKEECHOBEE BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-4629
Country	:	US
Telephone Number	:	561-682-9383
Fax Number	:

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

Provider Enumeration Date	:	09/05/2008
Last Update Date	:	09/05/2008

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Directions to “ MR. DAVID H BRODER LMT” Practice Location

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