Most Relevant Information
Provider Data
| NPI Number: | 1003496415 |
| Provider Name: | TIFFANY BRODERSEN PT, DPT, CLT-LANA |
| Entity Type: | Individual |
| Taxonomy Code: | 225100000X |
| Specialty: | Physical Therapist |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/09/2021 |
| Last Updated: | 04/09/2021 |
Provider Practice Location
2320 ROYAL BLVD
ELGIN
IL
601234717
Practice Location Phone/Fax
| Phone: | 2247836128 |
| Fax: |
Provider Mailing Location
1425 N RANDALL RD
ELGIN
IL
601232300
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |