Provider Demographics
NPI:1790794691
Name:BRODZIK, DEBORAH A (PT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:BRODZIK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 DUTCHMANS LANE
Mailing Address - Street 2:SUITE 515 SUBURBAN MEDICAL PLAZA III
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207
Mailing Address - Country:US
Mailing Address - Phone:502-895-2440
Mailing Address - Fax:502-897-2311
Practice Address - Street 1:4121 DUTCHMANS LANE
Practice Address - Street 2:SUITE 515 SUBURBAN MEDICAL PLAZA III
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-895-2440
Practice Address - Fax:502-897-2311
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY002736225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000039518OtherANTHEM
5060594OtherAETNA