Broderick, Jerome Daniel

Broderick, Jerome Daniel is an individual health care provider with primary practice located at 2911 Knapp St Ne Suite C, Grand Rapids MI 49525-4600. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Broderick, Jerome Daniel can be contacted via phone (616) 975-9078.

Contact Information

Primary practice address
2911 Knapp St Ne Suite C Grand Rapids MI 49525-4600
Phone: (616) 975-9078
Fax: (616) 975-9248
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X 5501010335 Michigan

Profile Details

NPI number 1881691962
LBN Legal business name Broderick, Jerome Daniel
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 5th, 2005
Last updated Mar 12th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1881691962 NPPES
Michigan Other 650D113250 BLUE CROSS BLUE SHIELD ID
Michigan Other P33049F BLUE CROSS BLUE SHIELD ID
Michigan Other JB010335 BLUE CROSS BLUE SHIELD ID

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