Provider Demographics
NPI:1972704278
Name:BROER, CLINT DEAN (RPT)
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:DEAN
Last Name:BROER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ONAWA
Mailing Address - State:IA
Mailing Address - Zip Code:51040-1750
Mailing Address - Country:US
Mailing Address - Phone:712-898-3711
Mailing Address - Fax:
Practice Address - Street 1:1720 15TH ST
Practice Address - Street 2:
Practice Address - City:ONAWA
Practice Address - State:IA
Practice Address - Zip Code:51040-1750
Practice Address - Country:US
Practice Address - Phone:712-898-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2014-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA03439225100000X
NE2162225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist