Provider Demographics
NPI:1487605572
Name:BROOME ORTHOPEDIC & SPORT PHYSICAL THERAPY
Entity type:Organization
Organization Name:BROOME ORTHOPEDIC & SPORT PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:PEAKE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-729-2200
Mailing Address - Street 1:800 VALLEY PLZ
Mailing Address - Street 2:SUITE 9
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1046
Mailing Address - Country:US
Mailing Address - Phone:607-729-2200
Mailing Address - Fax:607-729-2202
Practice Address - Street 1:800 VALLEY PLZ
Practice Address - Street 2:SUITE 9
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1046
Practice Address - Country:US
Practice Address - Phone:607-729-2200
Practice Address - Fax:607-729-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017381-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy