Provider Demographics
NPI:1225061484
Name:BROCIOUS, AMY LYNN (ATC, CSCS)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNN
Last Name:BROCIOUS
Suffix:
Gender:F
Credentials:ATC, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 21ST ST SW
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34117-4303
Mailing Address - Country:US
Mailing Address - Phone:239-352-9973
Mailing Address - Fax:
Practice Address - Street 1:5600 COUGAR DR
Practice Address - Street 2:BARRON COLLIER HIGH SCHOOL
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-5903
Practice Address - Country:US
Practice Address - Phone:239-377-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 10182255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer