Provider Demographics
NPI:1205398013
Name:BROTSKY, MITCHELL DEAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:DEAN
Last Name:BROTSKY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:352 2ND STREET PIKE UNIT 397
Mailing Address - Street 2:
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:PA
Mailing Address - Zip Code:18966-3834
Mailing Address - Country:US
Mailing Address - Phone:215-264-8351
Mailing Address - Fax:267-571-9947
Practice Address - Street 1:352 2ND STREET PIKE UNIT 397
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3834
Practice Address - Country:US
Practice Address - Phone:215-264-8351
Practice Address - Fax:267-571-9947
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025876208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty