Provider Demographics
NPI:1740594399
Name:BROOM, CAROLYN JANE
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:JANE
Last Name:BROOM
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:JANE
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:7927 STATE ROAD 52
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-6783
Mailing Address - Country:US
Mailing Address - Phone:727-863-5808
Mailing Address - Fax:
Practice Address - Street 1:7927 STATE ROAD 52
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-6783
Practice Address - Country:US
Practice Address - Phone:727-863-5808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT0008155225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist