Provider Demographics
NPI:1043096324
Name:BROADHURST, LOUIS ROBERT
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:ROBERT
Last Name:BROADHURST
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:LOUIS
Other - Middle Name:ROBERT
Other - Last Name:BROADHURST
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PTA
Mailing Address - Street 1:620 PARK ST
Mailing Address - Street 2:
Mailing Address - City:DONNELLSON
Mailing Address - State:IA
Mailing Address - Zip Code:52625-9628
Mailing Address - Country:US
Mailing Address - Phone:319-795-6495
Mailing Address - Fax:
Practice Address - Street 1:620 PARK ST
Practice Address - Street 2:
Practice Address - City:DONNELLSON
Practice Address - State:IA
Practice Address - Zip Code:52625-9628
Practice Address - Country:US
Practice Address - Phone:319-795-6495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant