Provider Demographics
NPI:1922191055
Name:BROUGHTON, DANA (MPT)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:BROUGHTON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:511 ALDEN BRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8396
Mailing Address - Country:US
Mailing Address - Phone:984-255-4105
Mailing Address - Fax:
Practice Address - Street 1:511 ALDEN BRIDGE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8396
Practice Address - Country:US
Practice Address - Phone:984-255-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP76122251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP7612OtherNORTH CAROLINA BOARD OF PHYSICAL THERAPY