Provider Demographics
NPI:1093835449
Name:BROOMS, CINDY LEE (LPTA)
Entity type:Individual
Prefix:MS
First Name:CINDY
Middle Name:LEE
Last Name:BROOMS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1123 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILLSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24343-1132
Mailing Address - Country:US
Mailing Address - Phone:276-728-2797
Mailing Address - Fax:
Practice Address - Street 1:16600 DANVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LAUREL FORK
Practice Address - State:VA
Practice Address - Zip Code:24352-3804
Practice Address - Country:US
Practice Address - Phone:276-398-2117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000640225200000X
225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant