Steven Broadway, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA001660 Issued in GA

Practice address

705 Breedlove Dr Ste 200
Monroe, GA 30655-2080

Phone

(770) 554-5009

NPI assigned

Aug 16, 2021

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

Other identifiers 1

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": "1629072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751328000000",
    "number": "1245905710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1765 OLD WEST BROAD ST BLDG 2-200",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306062887",
            "telephone_number": "706-549-1663",
            "fax_number": "706-546-8792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 BREEDLOVE DR STE 200",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306552080",
            "telephone_number": "770-554-5009"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1765 Old West Broad St",
            "address_purpose": "LOCATION",
            "city": "Athens",
            "state": "GA",
            "postal_code": "306062853",
            "country_code": "US",
            "telephone_number": "706-549-1663",
            "fax_number": "706-546-8792",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3440 Highway 81",
            "address_purpose": "LOCATION",
            "city": "Loganville",
            "state": "GA",
            "postal_code": "300529112",
            "country_code": "US",
            "telephone_number": "770-554-5009",
            "fax_number": "706-546-8792",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROADWAY",
        "first_name": "STEVEN",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-16",
        "last_updated": "2025-07-01",
        "certification_date": "2025-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA001660",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH NUMBER",
            "identifier": "15376405",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stephen Dale Bovenkerk, D.O.
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• Christina Bradford, FNP-C
• Kate Ann Breiner, NP
• Catilin Briscoe, NP
• Charon Brown
• Lawrence Michael Bruner Jr., NP-C
• Melissa Jones Bupp, APRN
• Sha'Teira Keyaji Burnett
• Diondra Trenee' Burney Atoyebi, D.O.

• All providers in Monroe, GA
• Physical Therapy Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2025; 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.