Broderick A Brass, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

3777 Issued in NV

Practice address

6440 Medical Center St Ste 100
Las Vegas, NV 89148-2404

Phone

(702) 222-1000

Fax

(702) 222-9448

NPI assigned

Aug 15, 2018

Last updated

Aug 15, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

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.

• Executive Fitness Inc

  dba Timothy B Soder Physical Therapy

  • Physical Therapist
  • Las Vegas, NV
  • NPI 1881710192
  Medicare reassignment NPD
• Executive Fitness Inc

  dba Tim Soder Physical Therapy

  • Specialist
  • Las Vegas, NV
  • NPI 1144552316
  NPD (past)

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

{
    "created_epoch": "1534291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534291200000",
    "number": "1538649025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6440 MEDICAL CENTER ST STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891482404",
            "telephone_number": "702-222-1000",
            "fax_number": "702-222-9448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6440 MEDICAL CENTER ST STE 100",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891482404",
            "telephone_number": "702-222-1000",
            "fax_number": "702-222-9448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRASS",
        "first_name": "BRODERICK",
        "middle_name": "A",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-15",
        "last_updated": "2018-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NV",
            "license": "3777",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NV STATE LICENSE",
            "identifier": "3777",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Riley Madison Brashear, MPAS, PA-C
• Rhea May Brasi
• Amber Fern Brasil, M.ED.
• Alexandra J Brass, PT, DPT
• Asia Brass
• Julandia Brass
• Katrinna Brass
• Krystal Kai Brass, LCSW
• Tamika Brass
• Patricia Brassett

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; 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.