Provider Demographics
NPI:1912653692
Name:BROE, MICHAEL EMMIT (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:EMMIT
Last Name:BROE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:EMMIT
Other - Last Name:BROE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:99 UNIVERSITY PL FL 9
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4528
Mailing Address - Country:US
Mailing Address - Phone:212-604-1316
Mailing Address - Fax:212-604-1320
Practice Address - Street 1:99 UNIVERSITY PL FL 9
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4528
Practice Address - Country:US
Practice Address - Phone:212-604-1316
Practice Address - Fax:212-604-1320
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist