Trevor D Broyles, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT015472 Issued in GA

Practice address

130 E Broad St
Camilla, GA 31730-1809

Phone

(229) 336-1115

Fax

(229) 336-1151

NPI assigned

Aug 10, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Flint River Physical Therapy. LLCGroup PAC ID 9234038662, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Flint River Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Camilla, GA
  • NPI 1164491015

  GA, Physical Therapist

  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1628553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628553600000",
    "number": "1043985336",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 E BROAD ST",
            "city": "CAMILLA",
            "state": "GA",
            "postal_code": "317301809",
            "telephone_number": "229-336-1115",
            "fax_number": "229-336-1151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 E BROAD ST",
            "city": "CAMILLA",
            "state": "GA",
            "postal_code": "317301809",
            "telephone_number": "229-336-1115",
            "fax_number": "229-336-1151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROYLES",
        "first_name": "TREVOR",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-10",
        "last_updated": "2021-08-10",
        "certification_date": "2021-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT015472",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trace Brantley, PHARMD
• Joshua Brazier
• Jana Hart Brock, FNP-C
• Jamekah Brooks, MS, CADCII
• Diangelia Brown
• Donald Christopher Brunelle, P.T.
• Amanda Bryant
• Randin Burley
• Shayla Burns
• Remell Butler

• All providers in Camilla, GA
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.