Christina Lynn Broome, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT009497 Issued in GA

Practice address

106 Pearl Dr Ste 104
La Fayette, GA 30728-7510

Phone

(706) 638-3880

Fax

(706) 638-3880

NPI assigned

Nov 6, 2008

Last updated

Jan 8, 2024By 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 identifiers 2

Other names 1

• Christina Lynn Wagner Former name

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Performance Physical Therapy and Sports Medicine IncGroup PAC ID 8426112137, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Performance Physical Therapy & Sports Medicine Inc

  • Physical Therapist
  • La Fayette, GA
  • NPI 1871738872
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1225929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704672000000",
    "number": "1730333550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 528",
            "city": "ROME",
            "state": "GA",
            "postal_code": "301620528",
            "telephone_number": "706-528-4207",
            "fax_number": "706-528-4211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "106 PEARL DR STE 104",
            "city": "LA FAYETTE",
            "state": "GA",
            "postal_code": "307287510",
            "telephone_number": "706-638-3880",
            "fax_number": "706-638-3880"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13423 Highway 27 Ste A",
            "address_purpose": "LOCATION",
            "city": "Trion",
            "state": "GA",
            "postal_code": "307531556",
            "country_code": "US",
            "telephone_number": "706-696-0505",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12415 N Main Street",
            "address_purpose": "LOCATION",
            "city": "Trenton",
            "state": "GA",
            "postal_code": "307523075",
            "country_code": "US",
            "telephone_number": "706-657-2700",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1711 Martha Berry Blvd NW",
            "address_purpose": "LOCATION",
            "city": "Rome",
            "state": "GA",
            "postal_code": "301651623",
            "country_code": "US",
            "telephone_number": "706-528-4207",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11638 Highway 27",
            "address_2": "Ste 1",
            "address_purpose": "LOCATION",
            "city": "Summerville",
            "state": "GA",
            "postal_code": "307478514",
            "country_code": "US",
            "telephone_number": "706-857-6366",
            "fax_number": "706-857-6372",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROOME",
        "first_name": "CHRISTINA",
        "middle_name": "LYNN",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-11-06",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "GA",
            "license": "PT009497",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "229928909B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "229928909A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTINA",
            "last_name": "WAGNER",
            "middle_name": "LYNN",
            "credential": "PT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Eric J Betts, M.D.
• Kelly Blevins
• Morgan Boles
• Ernest Lee Bowling, O.D.
• Megan Brackett
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• Kim Cameron
• Careatc
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• Physical Therapist in La Fayette, GA
• Providers in La Fayette, GA by specialty
• Physical Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.