Basic Information
| Provider Information | |||||||||
| NPI: | 1275921074 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROXEY-THOMAS | ||||||||
| FirstName: | THELMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1463 OAKFIELD DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335110802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136554166 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1463 OAKFIELD DR STE 130 | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335110802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136554166 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2014 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 101YM0800X | IMH577 | FL | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.