Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Cody O'Neal Broom

Individual provider Physical Therapy Assistant · NPI 1720738099

Cody O'Neal Broom is a Physical Therapy Assistant in Columbia, Mississippi. Works from 2 locations. Licensed in Mississippi.

Licensed in
MS
In the registry since
2022
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Practice location Address checks out

11 Pecan Dr
Columbia, MS 39429-2600
Phone: (601) 731-5717
Fax: (601) 633-0082
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3261 Highway 49, Collins, MS 39428-3876 — (601) 921-6043

Specialties & licences

Physical Therapy Assistant (primary) Taxonomy 225200000X · Licence PTA7008 (MS)

Record details

NPI number1720738099
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 28, 2022
Last updated in NPPESJune 22, 2022
Certification dateJune 22, 2022

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