Provider Demographics
NPI:1346925443
Name:BROKER, AIDAN AUGUST
Entity Type:Individual
Prefix:
First Name:AIDAN
Middle Name:AUGUST
Last Name:BROKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E 45TH ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-2112
Mailing Address - Country:US
Mailing Address - Phone:912-659-7679
Mailing Address - Fax:
Practice Address - Street 1:1 E 45TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-2112
Practice Address - Country:US
Practice Address - Phone:912-659-7679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer