Nicole Irene Broderick, LMT

NPI #1396375747 in East Islip, New York

Provider Information

NPI Number: 1396375747
Entity Type: Individual
Name: Nicole Irene Broderick, LMT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Credential: LMT
Enumeration Date: Jan 23, 2020
Last Updated: Jan 23, 2020

Practice Location

Address: 99 E MAIN ST STE 1
City: East Islip
State: New York
ZIP Code: 11730-2538
Phone: (631) 647-8324

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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