Samantha Brovelli, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

12864 Issued in WI

Practice address

110 Lone Oak LN
Hartford Health Center
Hartford, WI 53027-2600

Phone

(262) 670-1800

Fax

(262) 836-1601

NPI assigned

Nov 7, 2014

Last updated

Mar 8, 2016By 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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1415318400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457395200000",
    "number": "1881090579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 LONE OAK LN",
            "address_2": "HARTFORD HEALTH CENTER",
            "city": "HARTFORD",
            "state": "WI",
            "postal_code": "530272600",
            "telephone_number": "262-670-1800",
            "fax_number": "262-836-1601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 LONE OAK LN",
            "address_2": "HARTFORD HEALTH CENTER",
            "city": "HARTFORD",
            "state": "WI",
            "postal_code": "530272600",
            "telephone_number": "262-670-1800",
            "fax_number": "262-836-1601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROVELLI",
        "first_name": "SAMANTHA",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-11-07",
        "last_updated": "2016-03-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "12864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881090579",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mark R Bradley, D.O.
• Nicholas John Brahm, DO
• Edward Victor Braun, D.C.
• Greta Raye Braun, DO
• Joseph J Brenner, DDS MS
• Victoria Marie Brown, DC
• Jennifer May Bryant, D.C.
• Paul V Bullis, MD
• Patricia K Burmeister, RN
• Rachel Elizabeth Burtka, CCC-SLP

• Physical Therapist in Hartford, WI
• Providers in Hartford, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2016; 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.