Jake Broscha

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

0430 Issued in SD

Practice address

500 Vermillion St
Centerville, SD 57014-2168

Phone

(605) 563-2251

NPI assigned

Jun 5, 2015

Last updated

Jun 5, 2015By the provider in NPPES

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1433462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433462400000",
    "number": "1205216082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 E 15TH ST APT 304",
            "city": "YANKTON",
            "state": "SD",
            "postal_code": "570785010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 VERMILLION ST",
            "city": "CENTERVILLE",
            "state": "SD",
            "postal_code": "570142168",
            "telephone_number": "605-563-2251"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROSCHA",
        "first_name": "JAKE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-05",
        "last_updated": "2015-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "SD",
            "license": "0430",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bruce Adam Bennett, RN
• Courtney Blake
• Cody D Carstensen, PHARMD
• Centerville Care & Rehab Center Inc
• Centerville Community Ambulance Service, Inc.
• Centerville Development Corporation (Centerville Care and Rehab Center)
• Centerville School District 60-01

• Physical Therapy Assistant in Centerville, SD
• Providers in Centerville, SD by specialty
• Physical Therapy Assistant in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; 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.