Provider Demographics
NPI:1609751734
Name:BRODERICK, KATHERINE MARIE (DPT)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARIE
Last Name:BRODERICK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W MANTOLOKING DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08723-5807
Mailing Address - Country:US
Mailing Address - Phone:203-770-9414
Mailing Address - Fax:
Practice Address - Street 1:100 W MANTOLOKING DR
Practice Address - Street 2:
Practice Address - City:BRICK
Practice Address - State:NJ
Practice Address - Zip Code:08723-5807
Practice Address - Country:US
Practice Address - Phone:203-770-9414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA02027300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist