Provider Demographics
NPI:1538224282
Name:BROSIUS, DENNIS J (PT)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:J
Last Name:BROSIUS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24469 LA PONDEROSA
Mailing Address - Street 2:
Mailing Address - City:MATHIS
Mailing Address - State:TX
Mailing Address - Zip Code:78368-4505
Mailing Address - Country:US
Mailing Address - Phone:361-547-0274
Mailing Address - Fax:
Practice Address - Street 1:2500 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4169
Practice Address - Country:US
Practice Address - Phone:361-661-8130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1097855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist