Koenraad J Van Den Broeck, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT 12340 Issued in FL

Practice address

13201 Walsingham Rd
Largo, FL 33774-3518

Phone

(727) 593-7909

Fax

(727) 593-7897

NPI assigned

Jun 12, 2006

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 names 1

• Mr. Conrad Vandenbroeck Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1386686632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 SUN VISTA CT N",
            "city": "TREASURE ISLAND",
            "state": "FL",
            "postal_code": "337064475",
            "telephone_number": "727-363-7329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13201 WALSINGHAM RD",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337743518",
            "telephone_number": "727-593-7909",
            "fax_number": "727-593-7897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DEN BROECK",
        "first_name": "KOENRAAD",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "PT 12340",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CONRAD",
            "last_name": "VANDENBROECK",
            "prefix": "MR.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Physical Therapist in Largo, FL
• Providers in Largo, FL by specialty
• Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.