Provider Demographics
NPI:1801194212
Name:BROADHEAD, ANNE (DPT)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:
Last Name:BROADHEAD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WALTON PARK LN
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3028
Mailing Address - Country:US
Mailing Address - Phone:804-560-9575
Mailing Address - Fax:804-560-9557
Practice Address - Street 1:108 WALTON PARK LN
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3028
Practice Address - Country:US
Practice Address - Phone:804-560-9575
Practice Address - Fax:804-560-9557
Is Sole Proprietor?:No
Enumeration Date:2011-03-09
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206830225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist