Madonna Marie Broquet, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160.001738 Issued in IL

Practice address

3516 Waukegan Rd
McHenry, IL 60050-5732

Phone

(815) 271-5249

NPI assigned

Aug 24, 2011

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314144000000",
    "number": "1437439239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 369",
            "city": "LAKE VILLA",
            "state": "IL",
            "postal_code": "600460369",
            "telephone_number": "847-421-2148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3516 WAUKEGAN RD",
            "city": "MCHENRY",
            "state": "IL",
            "postal_code": "600505732",
            "telephone_number": "815-271-5249"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROQUET",
        "first_name": "MADONNA",
        "middle_name": "MARIE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-24",
        "last_updated": "2011-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160.001738",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "WI",
            "license": "1441-19",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Niki Briggs, LPC
• Jennifer Taylor Brinkman, LSW
• Jacqueline L Bristen
• Jaci Alexis Broderick
• Nancy K Brodson, SLP
• Daisha Brown
• Jamonique Ashanti Brown
• Tamika I Brown
• Jeanne Marie Browning, MS, APN, CHTP
• Katarzyna Maria Brozek, FNP

• Physical Therapy Assistant in McHenry, IL
• Providers in McHenry, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2011; 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.