Provider Demographics
NPI:1982672168
Name:BRODERICK, UNA MARY (PT)
Entity Type:Individual
Prefix:MRS
First Name:UNA
Middle Name:MARY
Last Name:BRODERICK
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 1:2980 CURTIS PL
Mailing Address - Street 2:
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793-3262
Mailing Address - Country:US
Mailing Address - Phone:516-826-2651
Mailing Address - Fax:
Practice Address - Street 1:2980 CURTIS PL
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3262
Practice Address - Country:US
Practice Address - Phone:516-826-2651
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist