Susan H Broderick, RPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

003751 Issued in CT

Practice address

590 Middlebury Rd
Suite a
Middlebury, CT 06762-2562

Phone

(203) 577-3700

Fax

(203) 577-3800

NPI assigned

Jul 9, 2010

Last updated

Jul 9, 2010By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Susan Haviland Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Advance Therapy Associates LLC

  • Early Intervention Provider Agency
  • Watertown, CT
  • NPI 1518124668
  NPD (past)

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

{
    "created_epoch": "1278633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278633600000",
    "number": "1669784401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1327",
            "city": "MIDDLEBURY",
            "state": "CT",
            "postal_code": "067627327",
            "telephone_number": "203-577-3700",
            "fax_number": "203-577-3800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 MIDDLEBURY RD",
            "address_2": "SUITE A",
            "city": "MIDDLEBURY",
            "state": "CT",
            "postal_code": "067622562",
            "telephone_number": "203-577-3700",
            "fax_number": "203-577-3800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "SUSAN",
        "middle_name": "H",
        "credential": "RPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-09",
        "last_updated": "2010-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CT",
            "license": "003751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUSAN",
            "last_name": "HAVILAND",
            "credential": "RPT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Black Cat Psychotherapy PLLC
• Victoria Anne Bosse, PSYD, LMFT
• Deana S Boucher, RD
• Patrice Kenyatta Boyce, LCSW
• Bright New Beginnings Counseling
• Carolyn Brown, NP
• Wilfred Brown, MD
• Alyssa Bugnacki, DC
• Gregory K. Buller, M.D.
• Gina Marie Burrows, APRN

• Physical Therapist in Middlebury, CT
• Providers in Middlebury, CT by specialty
• Physical Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2010; 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.