Debra Lynn Broderick

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA32057 Issued in FL

Practice address

2410 W Plaza Dr
Tallahassee, FL 32308-5325

Phone

(850) 385-6185

Fax

(850) 385-2580

NPI assigned

Feb 5, 2014

Last updated

Jun 28, 2022By 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 identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Regional Therapy Services Inc

  • Rehabilitation Clinic/Center
  • Tallahassee, FL
  • NPI 1588620355
  NPD (past)
• Regional Therapy Services Inc

  • Rehabilitation Clinic/Center
  • Moultrie, GA
  • NPI 1528024387
  NPD (past)

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

{
    "created_epoch": "1391558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656374400000",
    "number": "1417371840",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4099 SPAIN FERRY RD",
            "city": "VALDOSTA",
            "state": "GA",
            "postal_code": "316019119",
            "telephone_number": "229-561-4767",
            "fax_number": "229-890-3397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2410 W PLAZA DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323085325",
            "telephone_number": "850-385-6185",
            "fax_number": "850-385-2580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "DEBRA",
        "middle_name": "LYNN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-05",
        "last_updated": "2022-06-28",
        "certification_date": "2022-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "GA",
            "license": "PTA003216",
            "primary": false
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA32057",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICAL THERAPY ASSISTANT",
            "identifier": "PTA003216",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA BOARD OF PHYSICAL THERAPY",
            "identifier": "PTA32057",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paula K Brittain, RT CT MR
• Luke Byron Brocco, LCSW
• Amanda Lynn Brock
• Katie Carroll Brock, NBH-WHC
• Mary M Brock, R.N.
• Tim Alan Broeseker, MD
• Lynda A Brogdon, PH.D,
• Brenda Lee Broger, ARNP
• Lauren Brognano
• Sevilla Bronson

• Physical Therapy Assistant in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2022; 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.