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

Jake T Broccolo, DPT

Individual provider Physical Therapist · NPI 1144709114

Jake T Broccolo, DPT is a Physical Therapist in Private Practice in North Providence, Rhode Island. Qualified in 2018, 8 years ago. Practices with Silver Fern Practice LLC, a 296-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Massachusetts and Rhode Island.

Years since qualifying
8
Licensed in
MA, RI
In the registry since
2018
Specialties on file
2
What do these letters mean?
DPT — Doctor of Physical Therapy
The doctoral degree now required to enter physical therapy practice.

See every abbreviation used in this directory →

Practice location Address checks out

1401 Douglas Ave
North Providence, RI 02904-4058
Phone: (401) 726-7100
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1295 Fall River Ave, Seekonk, MA 02771-5931 — (508) 231-5944

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence PT03093 (RI)
Physical Therapist Taxonomy 225100000X · Licence PTL88684 (MA)

Record details

NPI number1144709114
Entity typeIndividual (Type 1)
GenderMale
Credentials DPT
Sole proprietorNo
NPI enumeratedAugust 10, 2018
Last updated in NPPESJanuary 30, 2026
Certification dateJanuary 30, 2026
Mailing address4 Richmond Sq, Providence, RI 02906-5117

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Silver Fern Practice Llc — 296 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in North Providence