Lauren Broussard

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PTH12105 Issued in AL

Practice address

38 Sheridan Park Cir Ste E
Bluffton, SC 29910-7023

Phone

(843) 757-5566

NPI assigned

Nov 26, 2024

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

Enrolled in WA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kitsap Physical Therapy and Sports Clinic PS IncGroup PAC ID 6507762333, 142 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Kitsap Physical Therapy and Sports Clinic PS Inc

  • Physical Therapist
  • Silverdale, WA
  • NPI 1912902347
  Medicare reassignment Care Compare group NPD
• Kitsap Physical Therapy and Sports Clinic PS Inc

  • Durable Medical Equipment & Medical Supplies
  • Kingston, WA
  • NPI 1700466083

  Physical Therapist

  NPD

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

{
    "created_epoch": "1732579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732579200000",
    "number": "1619793338",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1297 INDIANA AVE",
            "city": "THORSBY",
            "state": "AL",
            "postal_code": "35171",
            "telephone_number": "205-217-9091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38 SHERIDAN PARK CIR STE E",
            "city": "BLUFFTON",
            "state": "SC",
            "postal_code": "299107023",
            "telephone_number": "843-757-5566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "LAUREN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-26",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "CPO37146T",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "AL",
            "license": "PTH12105",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shawntral Maria Julia Brimm
• John Louis Brittis, MD
• Broad River Oncology LLC
• Robert J Brockman, MD
• Addie Elizabeth Broom, MHS, OTR/L
• Benisha R Brown
• Camden Benton Doughtie Brown, DMD, MS
• Chance Matthew Brown, DDS
• Laurie Brown
• Madison Faye Brown

• Physical Therapist in Bluffton, SC
• Providers in Bluffton, SC by specialty
• Physical Therapist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.