Brian Paul Broussard, DPT

Primary specialty

Sports Physical TherapistTaxonomy code 2251S0007X

License

PT34062 Issued in FL

Practice address

111 2ND Ave NE Ste 1401
St Petersburg, FL 33701-3480

Phone

(727) 258-7224

NPI assigned

Sep 2, 2017

Sex

Male

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

Not listed in the public Medicare enrollment file

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.

• Alliance Sports Rehab

  • Sports Physical Therapist
  • St Petersburg, FL
  • NPI 1033701123
  NPD Authorized official
• Alliance Regenerative and Performance Medicine, PLLC

  • Sports Medicine (Family Medicine) Physician
  • St Petersburg, FL
  • NPI 1104418292
  NPD
• Regenerative Orthopedics and Sports Medicine, LLC

  • Orthopaedic Surgery Physician
  • Washington, DC
  • NPI 1992458392
  NPD (past)

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

{
    "created_epoch": "1504310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623196800000",
    "number": "1750809448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 2ND AVE NE STE 1401",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337013480",
            "telephone_number": "727-258-7224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 2ND AVE NE STE 1401",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337013480",
            "telephone_number": "727-258-7224"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2751 Prosperity Ave",
            "address_purpose": "LOCATION",
            "city": "Fairfax",
            "state": "VA",
            "postal_code": "220314397",
            "country_code": "US",
            "telephone_number": "703-237-3930",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15049 Bruce B Downs Blvd",
            "address_purpose": "LOCATION",
            "city": "Tampa",
            "state": "FL",
            "postal_code": "336471388",
            "country_code": "US",
            "telephone_number": "813-563-7668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROUSSARD",
        "first_name": "BRIAN",
        "middle_name": "PAUL",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-02",
        "last_updated": "2021-06-09",
        "certification_date": "2021-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "VA",
            "license": "1679719421",
            "primary": false
        },
        {
            "code": "2251S0007X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Sports",
            "state": "FL",
            "license": "PT34062",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brookwood Florida - Central, Inc
• Brookwood Florida, Inc
• Craig C Broome, DMD
• Kimberly Brossard, DC
• Mary C Brothers, ARNP
• John Broussard, DO
• Tammy D Brower
• Belynda Deatrice Brown-Nelson
• Anisthesia Brown
• Bonnie K Brown

• Sports Physical Therapist in St Petersburg, FL
• Providers in St Petersburg, FL by specialty
• Sports Physical Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; 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.