Individual provider Active NPI

Mary Broadbent, PT

  • Physical Therapist
  • Flagstaff, AZ
National Provider Identifier
1154200665
Registry record updated Aug 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
8620 Issued in AZ
Practice address
460 N Switzer Canyon Dr
Flagstaff, AZ 86001-4899
Phone
(928) 440-3106
NPI assigned
Aug 28, 2025
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 8620 AZ Primary

Addresses

Primary practice location

460 N Switzer Canyon Dr
Flagstaff, AZ 86001-4899

Mailing address

51 Pine del Dr
Flagstaff, AZ 86005-9603
Phone (973) 767-3671

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251124001008 AZ Practitioner - Physical Therapist in Private Practice 9739671132 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Proof Physical Therapy and Performance LLCGroup PAC ID 2466736400, 4 clinicians

Practice addresses (Care Compare)

460 N Switzer Canyon Dr
Suite 400
Flagstaff, AZ 86001-4851
Phone (928) 440-3106

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
8620AZMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Proof Physical Therapy and Performance, LLC Physical Therapist CurrentSince Oct 23, 2025 Accepting new patients

Locations

460 N Switzer Canyon Dr
Ste 400
Flagstaff, AZ 86001
Phone (928) 440-3106

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1756339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756339200000",
    "number": "1154200665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 PINE DEL DR",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860059603",
            "telephone_number": "973-767-3671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "460 N SWITZER CANYON DR",
            "city": "FLAGSTAFF",
            "state": "AZ",
            "postal_code": "860014899",
            "telephone_number": "928-440-3106"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADBENT",
        "first_name": "MARY",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-08-28",
        "last_updated": "2025-08-28",
        "certification_date": "2025-08-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AZ",
            "license": "8620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flagstaff, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2025; 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.