Jake T Broccolo, DPT
Physical Therapist in North Providence, Rhode Island
1144709114- Practice location
- 1401 Douglas Ave, North Providence, RI 02904-4058
- Phone
- 401-726-7100
- Fax
- —
- Last updated
- January 30, 2026
Jake T Broccolo is a Physical Therapist based in North Providence, RI. Jake T Broccolo practices in North Providence, RI and has the professional credentials of DPT. The NPI Number for Jake T Broccolo is 1144709114 and holds a License No. PTL88684 (MA). The current practice location address for Jake T Broccolo is 1401 Douglas Ave, North Providence, RI 02904-4058 and can be reached out via phone at 401-726-7100.
Provider Profile Details
- NPI Number
- 1144709114
- Provider Name
- Jake T Broccolo
- Credential
- DPT
- Provider Entity Type
- Individual
- Gender
- Male
- Address
- 1401 Douglas Ave, North Providence, RI 02904-4058
- Phone Number
- 401-726-7100
- Primary Taxonomy
- Physical Therapist · 225100000X
- Sole Proprietor
- No
- Provider Enumeration Date
- August 10, 2018
- Last Update Date
- January 30, 2026
- Certification Date
- January 30, 2026
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 1401 Douglas Ave
North Providence, RI 02904-4058 - City
- North Providence
- State
- Rhode Island
- Zip
- 02904-4058
- Phone Number
- 401-726-7100
Provider Business Mailing Address Details
- Address
- 4 Richmond Sq
Providence, RI 02906-5117 - City
- Providence
- State
- RI
- Zip
- 02906-5117
- Phone Number
- 401-433-4172
- Fax Number
- 401-433-0612
License Information
- License Number (1)
- PTL88684
- License State (1)
- MA
- Taxonomy (1)
- Physical Therapist · 225100000X
- License Number (2)
- PT03093
- License State (2)
- RI
- Taxonomy (2)
- Physical Therapist · 225100000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
Other Physical Therapists near North Providence, RI
View all Physical Therapists in North Providence →Frequently Asked Questions
What is the NPI number of Jake T Broccolo, DPT?
The NPI number of Jake T Broccolo, DPT is 1144709114. It was assigned on August 10, 2018 and is currently active in the NPPES registry.
What is the specialty of Jake T Broccolo, DPT?
Jake T Broccolo, DPT is registered under the primary taxonomy Physical Therapist (code 225100000X), licensed in MA under license number PTL88684.
Where does Jake T Broccolo, DPT practice?
The practice location is 1401 Douglas Ave, North Providence, RI 02904-4058. The office can be reached at 401-726-7100 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1144709114 directly on the NPPES registry website.