Provider Demographics
NPI:1194967042
Name:BROMBEREK, LINDSEY JEAN
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:JEAN
Last Name:BROMBEREK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8619 S HOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-2919
Mailing Address - Country:US
Mailing Address - Phone:414-856-1888
Mailing Address - Fax:262-364-2248
Practice Address - Street 1:8619 S HOWELL AVE
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-2129
Practice Address - Country:US
Practice Address - Phone:414-856-1888
Practice Address - Fax:262-364-2248
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1571-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant