Mary K Broadwater, P.T

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT60035309 Issued in WA

Practice address

100 NE Northlake Way Ste 200B
Seattle, WA 98105-6869

Phone

(206) 547-7445

NPI assigned

Aug 19, 2008

Last updated

Jan 7, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mary K Breene Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Morgan Kriz PLLC

  dba Vestibular Therapy Specialists

  • Physical Therapy Clinic/Center
  • Seattle, WA
  • NPI 1194360255

  Physical Therapist

  NPD
• Sports Medicine and Rehab Therapy, Inc.

  • Physical Therapist
  • Bishop, CA
  • NPI 1528147907
  NPD (past)

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

{
    "created_epoch": "1219104000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452124800000",
    "number": "1386891505",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9046 PHINNEY AVE N",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981033719",
            "telephone_number": "206-547-7445",
            "fax_number": "206-913-2486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NE NORTHLAKE WAY STE 200B",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981056869",
            "telephone_number": "206-547-7445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWATER",
        "first_name": "MARY",
        "middle_name": "K",
        "credential": "P.T",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-19",
        "last_updated": "2016-01-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CA",
            "license": "35167",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WA",
            "license": "PT60035309",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "BREENE",
            "middle_name": "K",
            "credential": "DPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nancy Broaders
• Susan Broadhurst, OT
• Broadview Development Associates II (Ida Culver House Broadview Health Care Center)
• Broadview Development Associates II, a Limited Partnership (Ida Culver House, Broadview)
• Colin Broadwater
• Broadway Dental Care (Edward G Sutter DDS)
• Broadway Dental Center, Inc. (S. David Buck, DDS)
• Broadway Vision Source
• Nicole T Broas, ARNP
• Sandra Marie Broberg, L.AC.

• Physical Therapist in Seattle, WA
• Providers in Seattle, WA by specialty
• Physical Therapist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2016; 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.