Active NPI
Michelle Brodeur, DPT
- Physical Therapist
- Columbia, CT
National Provider Identifier
1790176485
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT30108
- Practice address
- 106 CT 66
Columbia, CT 06237-0623 - Phone
- (860) 228-0194
- NPI assigned
- Feb 17, 2015
- Last updated
- Apr 14, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT30108 | FL | Primary |
Addresses
Primary practice location
106 CT 66
Columbia, CT 06237-0623
Mailing address
106 CT 66
Columbia, CT 06237
Other practice location 1
4113 NW 6th St Ste C
Gainesville, FL 32609-0731
Phone (352) 376-6300
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| IB763Z | Other | FL | MEDICARE PTAN |
| Y0Q7S | Other | FL | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Crossroads Physical Therapy LLC | Physical Therapist | Current | Accepting new patients |
Locations
106 Route 66 E
Columbia, CT 06237
Phone (860) 228-0194
Organizations & group practices 1
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.
-
- Physical Therapist
- Columbia, CT
- NPI 1134295678
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1424131200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618358400000",
"number": "1790176485",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "106 CT 66",
"city": "COLUMBIA",
"state": "CT",
"postal_code": "06237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "106 CT 66",
"city": "COLUMBIA",
"state": "CT",
"postal_code": "062370623",
"telephone_number": "860-228-0194"
}
],
"practiceLocations": [
{
"address_1": "4113 NW 6th St Ste C",
"address_purpose": "LOCATION",
"city": "Gainesville",
"state": "FL",
"postal_code": "326090731",
"country_code": "US",
"telephone_number": "352-376-6300",
"fax_number": "352-372-0661",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BRODEUR",
"first_name": "MICHELLE",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-02-17",
"last_updated": "2021-04-14",
"certification_date": "2021-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "FL",
"license": "PT30108",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "IB763Z",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "Y0Q7S",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.