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

Revajo S. Broadwater, PT

Individual provider Physical Therapist · NPI 1023111317

Revajo S. Broadwater, PT is a Physical Therapist in Private Practice in Valdosta, Georgia. Qualified in 2006, 20 years ago. Accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
20
Licensed in
GA
In the registry since
2006
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

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Practice location Address checks out

3537 N Crossing Cir
Valdosta, GA 31602
Phone: (229) 333-0095
Fax: (229) 333-0756
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X · Licence 1473 (GA)

Record details

NPI number1023111317
Entity typeIndividual (Type 1)
GenderFemale
Credentials PT
Sole proprietorNo
NPI enumeratedSeptember 5, 2006
Last updated in NPPESJuly 8, 2007

Medicare enrollment

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

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2006 (20 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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