Provider Demographics
NPI:1841413200
Name:BROONER, AMY LYNN (PT,ATC)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:BROONER
Suffix:
Gender:F
Credentials:PT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 YORKTOWN RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-2108
Mailing Address - Country:US
Mailing Address - Phone:563-581-5791
Mailing Address - Fax:563-557-2834
Practice Address - Street 1:444 N GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6331
Practice Address - Country:US
Practice Address - Phone:563-589-2497
Practice Address - Fax:563-557-2834
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03767225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist