| Doctor Name: | MR. MATTHEW BROSTROM |
| NPI Number: | 1356400808 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MPT, CERT. MDT |
| License Number: | 5501010651 |
| Business Practice Address: | 22180 Pontiac Trl Ste. E South Lyon, MI - 481789097 |
| Business Phone Number: | 2484460155 |
| Business Fax Number: | 2484460177 |
| Mailing Address: | 22180 Pontiac Trl, Ste. E SOUTH LYON |
| State: | MI |
| Postal Code: | 481789097 |
| Phone Number: | 2484460155 |
| Fax Number: | 2484460177 |
| NPI Enumeration Date: | 12/08/2006 |
| NPI Last Update Date: | 03/08/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | 5501010651 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |