Provider Demographics
NPI:1992178644
Name:BROPHY, MICHAEL GERARD (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GERARD
Last Name:BROPHY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4404 BOXWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29577-2620
Mailing Address - Country:US
Mailing Address - Phone:864-542-7709
Mailing Address - Fax:
Practice Address - Street 1:4404 BOXWOOD ST
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29577-2620
Practice Address - Country:US
Practice Address - Phone:864-542-7709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-03
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC74002251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC100472071OtherDRIVER'S LICENSE