Active NPI
Paul Brodeur, PTA
- Physical Therapy Assistant
- Webster, MA
National Provider Identifier
1417185604
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2333
- Practice address
- 28 Stoughton Ave
Webster, MA 01570-2340 - Phone
- (508) 943-8337
- NPI assigned
- Jun 25, 2009
- Last updated
- Jun 25, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2333 | MA | Primary |
Addresses
Primary practice location
28 Stoughton Ave
Webster, MA 01570-2340
Mailing address
28 Stoughton Ave
Webster, MA 01570-2340
Phone (508) 943-8337
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 161216796 | Other | MA | TAX ID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2333 | MA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245888000000",
"number": "1417185604",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28 STOUGHTON AVE",
"city": "WEBSTER",
"state": "MA",
"postal_code": "015702340",
"telephone_number": "508-943-8337"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28 STOUGHTON AVE",
"city": "WEBSTER",
"state": "MA",
"postal_code": "015702340",
"telephone_number": "508-943-8337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODEUR",
"first_name": "PAUL",
"name_prefix": "Mr.",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-06-25",
"last_updated": "2009-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MA",
"license": "2333",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "161216796",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Webster, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.