Provider Demographics
NPI:1194194092
Name:BROKENSHIRE-CYR, JANELLE (MPT)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:BROKENSHIRE-CYR
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-1943
Mailing Address - Country:US
Mailing Address - Phone:650-255-1797
Mailing Address - Fax:650-593-8876
Practice Address - Street 1:1509 WINDING WAY
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-1943
Practice Address - Country:US
Practice Address - Phone:650-255-1797
Practice Address - Fax:650-593-8876
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29271225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist