Provider Demographics
NPI:1679898522
Name:BROGGI, MICHELLE B (RPT, PH D)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:B
Last Name:BROGGI
Suffix:
Gender:F
Credentials:RPT, PH D
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:
Other - Last Name:BRODERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:335 HIGHLAND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2549
Mailing Address - Country:US
Mailing Address - Phone:203-699-9264
Mailing Address - Fax:203-271-1241
Practice Address - Street 1:335 HIGHLAND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2549
Practice Address - Country:US
Practice Address - Phone:203-699-9264
Practice Address - Fax:203-271-1241
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3893225100000X, 2251N0400X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics