Matt Brokaw, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

160002429 Issued in IL

Practice address

300 Tenney St
Kewanee, IL 61443-3452

Phone

(309) 853-5500

NPI assigned

Jun 12, 2012

Last updated

Jun 12, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Advanced Physical Therapy Services, LTD

  dba Advanced Rehab and Sports Medicine

  • Physical Therapist
  • Bloomington, IL
  • NPI 1437141504
  NPD (past)
• Advanced Physical Therapy Services, LTD.

  dba Advanced Rehab and Sports Medicine

  • Physical Therapist
  • Kewanee, IL
  • NPI 1184882961
  NPD (past)

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

{
    "created_epoch": "1339459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1339459200000",
    "number": "1871855155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 N WILLIAMSBURG DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043528",
            "telephone_number": "309-661-8823",
            "fax_number": "309-661-8801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 TENNEY ST",
            "city": "KEWANEE",
            "state": "IL",
            "postal_code": "614433452",
            "telephone_number": "309-853-5500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROKAW",
        "first_name": "MATT",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-06-12",
        "last_updated": "2012-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "IL",
            "license": "160002429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bridgeway Inc
• Bridgeway, Inc
• Bridgeway, Inc
• Bridgeway, Inc
• Jennifer Brokaw, F.N.P.
• Katelyn Rachelle Brooks, NP
• Amanda Brown
• Daniel Bryan, PT
• Scott Allen Camey, RPH
• Care Connect of Illinois Providers PLLC

• Physical Therapy Assistant in Kewanee, IL
• Providers in Kewanee, IL by specialty
• Physical Therapy Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2012; 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.