Broadway Physical Therapy LLC

Primary specialty

Physical Therapy Clinic/CenterTaxonomy code 261QP2000X

License

016088 Issued in NY

Legal business name

BROADWAY PHYSICAL THERAPY LLC

Practice address

289 Broadway
Staten Island, NY 10310-2004

Phone

(718) 448-4500

Fax

(718) 448-4506

NPI assigned

Aug 8, 2006

Last updated

Dec 11, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Thobile Prudence Sibanda, PHYSICAL THERAPISTNPI 1306176169

Title

Owner

Phone

(718) 448-4500

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Thobile Sibanda, PT.

  • Physical Therapist
  • Edison, NJ
  • NPI 1306176169
  NPD Authorized official

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

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702252800000",
    "number": "1649280199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "289 BROADWAY",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103102004",
            "telephone_number": "718-448-4500",
            "fax_number": "718-448-4506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "289 BROADWAY",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103102004",
            "telephone_number": "718-448-4500",
            "fax_number": "718-448-4506"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY PHYSICAL THERAPY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2023-12-11",
        "certification_date": "2023-12-11",
        "status": "A",
        "authorized_official_last_name": "SIBANDA",
        "authorized_official_first_name": "THOBILE",
        "authorized_official_middle_name": "PRUDENCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-448-4500",
        "authorized_official_credential": "PHYSICAL THERAPIST"
    },
    "taxonomies": [
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "NY",
            "license": "016088",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02647758",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marie E Briody, PHD
• Svetlana Briskman, CCC-SLP
• Kaitlin Bristol, OTR/L
• Kira Brits
• Broad Street Pharma Corp (broad street pharmacy)
• Catrine Brobbey
• Joel Brock, M.D
• Alina Brodskaya, NP
• Joseph Anthony Brogna, D.C.
• Vincent J Broillet, MD

• Physical Therapy Clinic/Center in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Physical Therapy Clinic/Center in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2023; 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.