Broad River Rehabilitation

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

BROAD RIVER REHABILITATION

Doing business as

Broad River Rehab

Practice address

48 Osprey Village Dr
Fernandina Beach, FL 32034-4955

Phone

(904) 440-0175

NPI assigned

Nov 28, 2022

Last updated

Nov 28, 2022By 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

Annette Hassen

Title

Credentialing Specialist

Phone

(828) 774-5222

Specialties & licenses 3

Addresses

Other names 1

• Broad River Rehab Doing business as

Tax ID family

Brookstone of Thomasville3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Broad River Rehabilitation

  • Physical Therapist
  • Rome, GA
  • NPI 1417732835
  NPD tax ID
• Broad River Rehabilitation

  dba Broad River Rehab

  • Physical Therapist
  • Lawton, OK
  • NPI 1871368027
  NPD tax ID

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

{
    "created_epoch": "1669593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669593600000",
    "number": "1679283998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 POND ST",
            "city": "ARDEN",
            "state": "NC",
            "postal_code": "287048500",
            "telephone_number": "828-774-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "48 OSPREY VILLAGE DR",
            "city": "FERNANDINA BEACH",
            "state": "FL",
            "postal_code": "320344955",
            "telephone_number": "904-440-0175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROAD RIVER REHABILITATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-28",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "status": "A",
        "authorized_official_last_name": "HASSEN",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "828-774-5222"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broad River Rehab",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicholas John Bremer, M.D.
• Bridges Behavioral Consulting
• Karisa Bridwell
• Robin Briggs, PAC
• Bright Smiles Pediatric Dentistry Nassau LLC (Bright Smiles Pediatric Dentistry)
• Charlesetta Nicole Brown, APRN
• Mark A Brown, DC
• Bruce S. West
• Jessica Anne Bruland, APRN
• George Brummer

• Speech-Language Pathologist in Fernandina Beach, FL
• Providers in Fernandina Beach, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; 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.