Provider Demographics
NPI:1215598750
Name:BROEKER, DARBY (ATC)
Entity Type:Individual
Prefix:
First Name:DARBY
Middle Name:
Last Name:BROEKER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 RIVERTON PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-3546
Mailing Address - Country:US
Mailing Address - Phone:925-301-6146
Mailing Address - Fax:
Practice Address - Street 1:237 RIVERTON PL
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-3546
Practice Address - Country:US
Practice Address - Phone:925-301-6146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer