Provider Demographics
NPI:1629215835
Name:BROGA, LINDA MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:MARIE
Last Name:BROGA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:MARIE
Other - Last Name:FOOTE-BROGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:59 PARKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-7424
Mailing Address - Country:US
Mailing Address - Phone:850-926-5965
Mailing Address - Fax:850-926-5965
Practice Address - Street 1:59 PARKSIDE CIR
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-7424
Practice Address - Country:US
Practice Address - Phone:850-926-5965
Practice Address - Fax:850-926-5965
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0019256225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist