Provider Demographics
NPI:1306077524
Name:BROSHUIS, ALICIA CHRISTINE (PT)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:CHRISTINE
Last Name:BROSHUIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:C
Other - Last Name:PAPA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:600 OAKMONT LN
Mailing Address - Street 2:STE 600C
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5548
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:630-928-5080
Practice Address - Street 1:8622 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:OLIVETTE
Practice Address - State:MO
Practice Address - Zip Code:63132-2504
Practice Address - Country:US
Practice Address - Phone:314-781-0679
Practice Address - Fax:314-781-3448
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005027555225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist