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NPI Code Detail

MEDICARE: JOHN T BROADWAY PT

MEDICARE: JOHN T BROADWAY PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist24740MA
2225100000XPhysical Therapist18673MD

General Provider Information

NPI Number : 1124099668
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN T BROADWAY PT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 630-296-2222
Fax Number : 630-759-9510
Provider Business Practice Location Address
First Line : 8890 CENTRE PARK DR STE 400
Second Line :
City : COLUMBIA
State : MD
Zip : 21045-2170
Country : US
Telephone Number : 410-884-6000
Fax Number : 410-884-9990
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/01/2006
Last Update Date : 02/09/2023

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