Deidra Broderick

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

27995 Issued in MD

Practice address

14280 Walsingham Rd
Largo, FL 33774-3231

Phone

(727) 596-2101

NPI assigned

Mar 1, 2019

Last updated

May 11, 2021By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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

{
    "created_epoch": "1551398400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620691200000",
    "number": "1760949341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14280 WALSINGHAM RD",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337743231"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14280 WALSINGHAM RD",
            "city": "LARGO",
            "state": "FL",
            "postal_code": "337743231",
            "telephone_number": "727-596-2101"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "31 Magothy Beach Rd Ste 105",
            "address_purpose": "LOCATION",
            "city": "Pasadena",
            "state": "MD",
            "postal_code": "211224423",
            "country_code": "US",
            "telephone_number": "410-437-3333",
            "fax_number": "410-437-4042",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRODERICK",
        "first_name": "DEIDRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-01",
        "last_updated": "2021-05-11",
        "certification_date": "2021-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "FL",
            "license": "34389",
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "27995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rachael Bridges, PHARMD
• Richard Fairlie Brinkley, LCSW, CAP, NCGC II
• Nilson Dos Reis Brito
• India Britten
• Darlene E Brockway, RMHCI
• Mary Bronk, RN
• Mieka Brooks-Hawkins
• Bryan Brown, DO
• David Alan Brown, DMD
• Durriell D Brown, D.O.

• Physical Therapist in Largo, FL
• Providers in Largo, FL by specialty
• Physical Therapist in Florida

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