Teri Doreen Broadway

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

5502001180 Issued in MI

Practice address

1901 N Telegraph Rd
Waterford, MI 48328-1878

Phone

(810) 407-9103

NPI assigned

Nov 14, 2018

Sex

Female

Sole proprietor

Yes

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": "1542153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542153600000",
    "number": "1376012708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 N TELEGRAPH RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483281878",
            "telephone_number": "810-407-9103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 N TELEGRAPH RD",
            "city": "WATERFORD",
            "state": "MI",
            "postal_code": "483281878",
            "telephone_number": "810-407-9103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWAY",
        "first_name": "TERI",
        "middle_name": "DOREEN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-11-14",
        "last_updated": "2018-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "MI",
            "license": "5502001180",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Briggs
• Bright Pine, Inc.
• Bright Start Home Wellness Inc
• Robert Julian Brill, LLMSW
• Christine Anne Brisson, OD
• Ashley Brokenshaw
• Alicia Dolores Brown, MA,LPC
• Elizabeth Ann Brown, NP
• Kim Diane Brown
• Micah Brown

• Physical Therapy Assistant in Waterford, MI
• Providers in Waterford, MI by specialty
• Physical Therapy Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; 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.