Heather S Broglio, PT CSCS

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

7667 Issued in MA

Practice address

290 Baker Ave
Ste 111
Concord, MA 01742

Phone

(978) 369-0730

Fax

(978) 371-7499

NPI assigned

Jul 8, 2006

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 2

Other names 1

• Heather Stark Former name

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": "1152316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972536498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 R SOUTH COMMONS",
            "city": "LINCOLN",
            "state": "MA",
            "postal_code": "01773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 BAKER AVE",
            "address_2": "STE 111",
            "city": "CONCORD",
            "state": "MA",
            "postal_code": "01742",
            "telephone_number": "978-369-0730",
            "fax_number": "978-371-7499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROGLIO",
        "first_name": "HEATHER",
        "middle_name": "S",
        "credential": "PT CSCS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MA",
            "license": "7667",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "Y67794",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0703613",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "STARK",
            "credential": "PT CSCS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Physical Therapist in Concord, MA
• Providers in Concord, MA by specialty
• Physical Therapist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.