Provider Demographics
NPI:1427577139
Name:BROSARD, KAREN ELIZABETH (PTA)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ELIZABETH
Last Name:BROSARD
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WALMART DR STE 5
Mailing Address - Street 2:
Mailing Address - City:MORRILTON
Mailing Address - State:AR
Mailing Address - Zip Code:72110-4525
Mailing Address - Country:US
Mailing Address - Phone:501-733-7597
Mailing Address - Fax:
Practice Address - Street 1:100 WALMART DR STE 5
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4525
Practice Address - Country:US
Practice Address - Phone:501-733-7597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPENDINGMedicaid