Provider Demographics
NPI:1437200607
Name:BROUSSARD, CHRIS (PT)
Entity Type:Individual
Prefix:
First Name:CHRIS
Middle Name:
Last Name:BROUSSARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6161 HARRY HINES BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-5306
Mailing Address - Country:US
Mailing Address - Phone:214-905-9555
Mailing Address - Fax:214-905-9556
Practice Address - Street 1:6161 HARRY HINES BLVD STE 105
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75235-5306
Practice Address - Country:US
Practice Address - Phone:214-905-9555
Practice Address - Fax:214-905-9556
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1098317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist