Provider Demographics
NPI:1093915183
Name:BROSKY, PAM (PT)
Entity Type:Individual
Prefix:MS
First Name:PAM
Middle Name:
Last Name:BROSKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 COCONUT CREEK PKWY STE 303
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1651
Mailing Address - Country:US
Mailing Address - Phone:954-972-9285
Mailing Address - Fax:
Practice Address - Street 1:1801 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1442
Practice Address - Country:US
Practice Address - Phone:877-993-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2019-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY7802OtherBLUE CROSS BLUE SHIELD PR
FLY7802ZMedicare PIN