Provider Demographics
NPI:1609983006
Name:BROOM, ROBIN (MS PT)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:
Last Name:BROOM
Suffix:
Gender:F
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 N GRIMES ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-1816
Mailing Address - Country:US
Mailing Address - Phone:505-392-4129
Mailing Address - Fax:505-392-3835
Practice Address - Street 1:2700 N GRIMES ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-1816
Practice Address - Country:US
Practice Address - Phone:505-392-4129
Practice Address - Fax:505-392-3835
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2953225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQMYPR0067389OtherMOLINA ID
NM2387OtherLOVELACE ID
NM003OtherHCH ID
NMNM00Q387OtherBLUE CROSS ID