Mark Robert Broadhead, PT
Individual provider Active NPI Physical Therapist · Livingston, MT
NPI 1154765766 · NPPES record last updated Jun 21, 2017
Key facts
- NPI
- 1154765766
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 5784 (MT)
- Practice address
- 510 S 14TH St
Livingston, MT 59047-3731 - Phone
- (406) 222-0672
- NPI assigned
- Apr 25, 2013
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5784 | MT | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5784 | MT | Yes |
Addresses
Primary practice location
510 S 14TH St
Livingston, MT 59047-3731
Mailing address
165 Smokey Hollow Rd
Bozeman, MT 59715
Phone (406) 581-5709
Other providers in Livingston, MT
- Heather Bolte
- Paula Terese Bradley-Guay
- Breathing Room Counseling, LLC
- Marci Breitbach
- Carrie Brewster
- Brynn Burbach
- Blake Burkert
- Elizabeth Brianne Burnett
- Cheyann Calendrillo
- Amory Cameron
All providers in Livingston, MT · Physical Therapist in Montana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.