Broberg Physical Therapy LV LLC

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

Legal business name

BROBERG PHYSICAL THERAPY LV LLC

Practice address

10080 W Tropicana Ave Ste 164
Las Vegas, NV 89147-8464

Phone

(408) 202-2011

NPI assigned

Jun 4, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Wayne Broberg, MPTNPI 1982793477

Title

Owner

Phone

(408) 202-2011

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Wayne Broberg, PT

  • Physical Therapist
  • San Jose, CA
  • NPI 1982793477

  NV

  Medicare reassignment NPD Authorized official
• Melani Kim Cabanayan, DPT

  • Physical Therapist
  • Las Vegas, NV
  • NPI 1083213060
  NPD

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

{
    "created_epoch": "1717459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717459200000",
    "number": "1417798281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10080 W TROPICANA AVE STE 164",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891478464",
            "telephone_number": "408-202-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10080 W TROPICANA AVE STE 164",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891478464",
            "telephone_number": "408-202-2011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROBERG PHYSICAL THERAPY LV LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-04",
        "last_updated": "2024-06-04",
        "certification_date": "2024-06-04",
        "status": "A",
        "authorized_official_last_name": "BROBERG",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "408-202-2011",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MPT"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pascha Nicole Broadie
• Decricia Broadnax
• Olubukunola Broadnax
• Lynnette Broadway
• Ama B. Brobbey, M.D.
• Janel Broberg
• Gerardo Broche
• Brock Occupational Health & Wellness
• Angela Denise Brock, APRN
• Corinne Deva Brock

• Orthopedic Physical Therapist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Orthopedic Physical Therapist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.