NPIMap

Organization Active NPI

Broadway Ergonomics, LLC

  • Orthopedic Physical Therapist
  • Columbia, MO
National Provider Identifier
1982959011
Registry record updated Jul 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopedic Physical TherapistTaxonomy code 2251X0800X
License
2010028179 Issued in MO
Legal business name
BROADWAY ERGONOMICS, LLC
Practice address
111 E Broadway
Suite 340
Columbia, MO 65203-4208
Phone
(573) 808-2392
Fax
(888) 738-3034
NPI assigned
Jul 15, 2012
Last updated
Jul 15, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2012

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

Authorized official

Name
Dr. Bret Sheridan Derrick, P.T.NPI 1861699639
Title
Partner
Phone
(573) 808-2392

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ergonomics Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251E1200X 02148 MO
Orthopedic Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 2251X0800X 2010028179 MO Primary

Addresses

Primary practice location

111 E Broadway
Suite 340
Columbia, MO 65203-4208

Mailing address

111 E Broadway
Suite 340
Columbia, MO 65203-4208
Phone (573) 808-2392

National Provider Directory

National Provider Directory

Locations

111 E Broadway
Ste 34
Columbia, MO 65203
Phone (573) 808-2392

111 E Broadway
Ste 340
Columbia, MO 65203
Phone (573) 268-4524

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1342310400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1342310400000",
    "number": "1982959011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 E BROADWAY",
            "address_2": "SUITE 340",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652034208",
            "telephone_number": "573-808-2392",
            "fax_number": "888-738-3034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 E BROADWAY",
            "address_2": "SUITE 340",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652034208",
            "telephone_number": "573-808-2392",
            "fax_number": "888-738-3034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY ERGONOMICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-15",
        "last_updated": "2012-07-15",
        "status": "A",
        "authorized_official_last_name": "DERRICK",
        "authorized_official_first_name": "BRET",
        "authorized_official_middle_name": "SHERIDAN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "573-808-2392",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "P.T."
    },
    "taxonomies": [
        {
            "code": "2251E1200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Ergonomics",
            "state": "MO",
            "license": "02148",
            "primary": false
        },
        {
            "code": "2251X0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist, Orthopedic",
            "state": "MO",
            "license": "2010028179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 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.