Provider Demographics
NPI:1184810897
Name:BROOM, JULIE (PTA)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:BROOM
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18945 FM 2252
Mailing Address - Street 2:SUITE 115
Mailing Address - City:GARDEN RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:78266-2562
Mailing Address - Country:US
Mailing Address - Phone:210-564-6602
Mailing Address - Fax:210-651-0029
Practice Address - Street 1:18945 FM 2252
Practice Address - Street 2:SUITE 115
Practice Address - City:GARDEN RIDGE
Practice Address - State:TX
Practice Address - Zip Code:78266-2562
Practice Address - Country:US
Practice Address - Phone:210-564-6602
Practice Address - Fax:210-651-0029
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-18
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI1222-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant