Active NPI
Lauren Broderick, DPT
- Pediatric Physical Therapist
- Austin, TX
National Provider Identifier
1104228535
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Physical Therapist
- License
- 1246961
- Practice address
- 9101 Burnet Rd
Suite 101
Austin, TX 78758-5254 - Phone
- (512) 248-2422
- Fax
- (512) 248-2354
- NPI assigned
- Sep 17, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Physical Therapist | 2251P0200X | 1246961 | TX | Primary |
Addresses
Primary practice location
9101 Burnet Rd
Suite 101
Austin, TX 78758-5254
Mailing address
9101 Burnet Rd
Suite 101
Austin, TX 78758-5254
Phone (512) 248-2422
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1246961 | TX | MD | Pediatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1410912000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410912000000",
"number": "1104228535",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9101 BURNET RD",
"address_2": "SUITE 101",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787585254",
"telephone_number": "512-248-2422",
"fax_number": "512-248-2354"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9101 BURNET RD",
"address_2": "SUITE 101",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787585254",
"telephone_number": "512-248-2422",
"fax_number": "512-248-2354"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODERICK",
"first_name": "LAUREN",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-17",
"last_updated": "2014-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "2251P0200X",
"taxonomy_group": "",
"desc": "Physical Therapist, Pediatrics",
"state": "TX",
"license": "1246961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.