Provider Demographics
NPI:1871500108
Name:BRODNICK, ALLEN PERRY (PT)
Entity Type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:PERRY
Last Name:BRODNICK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6410 ROCKLEDGE DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817
Mailing Address - Country:US
Mailing Address - Phone:301-897-0357
Mailing Address - Fax:301-897-2148
Practice Address - Street 1:6410 ROCKLEDGE DR
Practice Address - Street 2:SUITE 301
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817
Practice Address - Country:US
Practice Address - Phone:301-897-0357
Practice Address - Fax:301-897-2148
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15634225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist