Thomas Broback, DPT, CSCS

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

10800 Issued in MN

Practice address

14382 60TH St N
Stillwater, MN 55082-6311

Phone

(651) 342-0509

NPI assigned

Sep 6, 2017

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1504656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582156800000",
    "number": "1063930493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4281 143RD ST W",
            "city": "ROSEMOUNT",
            "state": "MN",
            "postal_code": "550683671",
            "telephone_number": "651-395-1352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14382 60TH ST N",
            "city": "STILLWATER",
            "state": "MN",
            "postal_code": "550826311",
            "telephone_number": "651-342-0509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROBACK",
        "first_name": "THOMAS",
        "credential": "DPT, CSCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-09-06",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MN",
            "license": "10800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Wesley Bransford, MD
• Catherine Kosiapo Breiwick, CNP
• Bridge Pca, Inc.
• Bridgeview Chiropractic, P.a.
• Lindsay Beth Briggs, DC
• Eden Broberg, MA
• Patrick John Brod, MD
• Beth Ann Bronski, OTR
• Lucy Brooks, MA
• Melissa Brown

• Orthopedic Physical Therapist in Stillwater, MN
• Providers in Stillwater, MN by specialty
• Orthopedic Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.