Broussard, Roberta Ruth

Broussard, Roberta Ruth is an sole proprietor health care provider with primary practice located at 4400 Bayou Blvd Suite 47B, Pensacola FL 32503-2673. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Massage Therapist, which is considered as her primary health care specialty. Broussard, Roberta Ruth can be contacted via phone (850) 516-4574.

Contact Information

Primary practice address
4400 Bayou Blvd Suite 47B Pensacola FL 32503-2673
Phone: (850) 516-4574
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Massage Therapist 225700000X MA33306 Florida

Profile Details

NPI number 1770761256
LBN Legal business name Broussard, Roberta Ruth
Credentials LMT
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 6th, 2008
Last updated Feb 6th, 2008 - about 18 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 1770761256 NPPES
Florida Other C2164 BLUE CROSS BLUE SHIELD

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