COLIN MICHAEL BRODERICK (NPI# 1982089066) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982089066 |
| Entity Type | Individual |
| Full Name | COLIN MICHAEL BRODERICK |
| Practice Address |
11925 Ellwood Greens Rd Genoa IL 60135-8142 |
| Practice Telephone | 7793820235 |
| Mailing Telephone | 7793820235 |
| Enumeration Date | 2015-07-30 |
| Last Update Date | 2015-07-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
WI | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | WI | Student, Health Care |
| Street Address |
11925 ELLWOOD GREENS RD |
| City | GENOA |
| State | IL |
| Zip Code | 60135-8142 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821697830 | Mayuri Prashant Shende | Student in an Organized Health Care Education/Training Program | 2160 S. First Ave., Bldg. 105, Suite 2840a, Marywood, IL 60135 | 2020-10-21 |
| 1831368612 | Northern Rehabilitation and Sports Medicine Associates | Physical Therapist | 540 E Main Street, Suite 5, Genoa, IL 60135 | 2008-02-26 |
| 1578582474 | Steven J Disanti | General Practice | 109 South Genoa Street, Genoa Medical Clinic, Genoa, IL 60135 | 2006-07-19 |
| 1558828947 | Victoria Elizabeth Deku | Speech-Language Pathologist | 123 W 1st St, Genoa, IL 60135-1016 | 2019-02-22 |
| 1134321698 | Genoa Kingston Cusd 424 | Local Education Agency (LEA) | 941 W Main St, Genoa, IL 60135-1037 | 2007-06-05 |
| 1992256309 | Angela Moore | Nurse's Aide | 519 W 2nd St, Genoa, IL 60135-1058 | 2016-10-20 |
| 1609887918 | Martha Ann Moegling | Chiropractor | 112 N Emmett St Ste A, Genoa, IL 60135-1087 | 2006-08-11 |
| 1306858154 | Natural Family Health S.c. | Chiropractor | 112 N Emmett St Ste A, Genoa, IL 60135-1087 | 2006-08-12 |
| 1013939602 | Steven J. Disanti D.o. S.c. | Family Medicine | 109 S Genoa St, Genoa, IL 60135-1120 | 2006-07-24 |
| 1659511632 | Sherie Anne Perdue | Dentist | 209 W Main St, Genoa, IL 60135-1145 | 2009-03-03 |
| Find all providers in zip 60135 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881003762 | Samantha Wilson | Specialist/Technologist | 2980 N Genoa Clay Center Rd, Genoa, OH 43430-9733 | 2014-08-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538771076 | Stacey Weathers-cannon | Specialist/Technologist | 650 Ingraham Ave, Calumet City, IL 60409-4236 | 2020-08-17 |
| 1104438621 | Abril Malagon | Specialist/Technologist | 1 S Greenwood Ave, Palatine, IL 60074-6328 | 2020-08-17 |
| 1265050678 | Megan Elsbree | Specialist/Technologist | 11819 Deacon Dr, Rockton, IL 61072-9411 | 2020-07-13 |
| 1013534437 | Nicole Rose Mondelli | Specialist/Technologist | 958 Tallgrass Dr, Bartlett, IL 60103-5071 | 2020-07-01 |
| 1740806413 | Megan Herter | Specialist/Technologist | 1513 Old Ivy Dr, Springfield, IL 62711-8156 | 2020-06-18 |
| 1164047239 | Madison Stagman | Specialist/Technologist | 280 Douglas Ave Apt 4, Mascoutah, IL 62258-2963 | 2020-06-14 |
| 1588286272 | Sarah Wegrzyn | Specialist/Technologist | 3040 S Wabash Ave, Chicago, IL 60616-3474 | 2020-05-15 |
| 1336761386 | Christine Louise Shebelski | Specialist/Technologist | 15203 Pulaski Rd, Midlothian, IL 60445-3755 | 2020-05-13 |
| 1386266633 | Kathryn Riordan | Specialist/Technologist | 221 Triton Ln, Naperville, IL 60540-7926 | 2020-05-09 |
| 1487276747 | Vianey Hernandez-ramirez | Specialist/Technologist | 4115 Howard St, Skokie, IL 60076-3749 | 2020-05-09 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.