MEDICARE: BROOME ORTHOPEDIC & SPORT PHYSICAL THERAPY

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
1	261QP2000X	Physical Therapy Clinic/Center	017381-1	NY

General Provider Information

NPI Number	:	1487605572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOME ORTHOPEDIC & SPORT PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	800 VALLEY PLZ
Second Line	:	SUITE 9
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1046
Country	:	US
Telephone Number	:	607-729-2200
Fax Number	:	607-729-2202

Provider Business Practice Location Address
First Line	:	800 VALLEY PLZ
Second Line	:	SUITE 9
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1046
Country	:	US
Telephone Number	:	607-729-2200
Fax Number	:	607-729-2202

Authorized Official
Title or Position	:	OWNER/PHYSICAL THERAPIST
Name	:	MR. GREGORY TODD PEAKE
Credential	:	PT
Telephone Number	:	607-729-2200

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	08/22/2020

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Directions to “BROOME ORTHOPEDIC & SPORT PHYSICAL THERAPY ” Practice Location

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