Provider Demographics
NPI:1851933535
Name:BRODBECK, ALEXA (DPT)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:BRODBECK
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 1:431 BLUE JACKET RD
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-6365
Mailing Address - Country:US
Mailing Address - Phone:419-410-8971
Mailing Address - Fax:
Practice Address - Street 1:816 MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:OH
Practice Address - Zip Code:43515-1463
Practice Address - Country:US
Practice Address - Phone:419-410-8971
Practice Address - Fax:419-822-0334
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501018756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist