| Doctor Name: | BRODIE JAMES PACK |
| NPI Number: | 1871578203 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MPT |
| License Number: | PT28869 |
| Business Practice Address: | 24582 Del Prado Suite E Dana Point, CA - 926293843 |
| Business Phone Number: | 9494430713 |
| Business Fax Number: | 9494430721 |
| Mailing Address: | Po Box 3255, DANA POINT |
| State: | CA |
| Postal Code: | 926298255 |
| Phone Number: | 9494430713 |
| Fax Number: | 9494430721 |
| NPI Enumeration Date: | 12/08/2005 |
| NPI Last Update Date: | 09/25/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT28869 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| 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 |