1003031139 NPI number — MARY CATHLEEN BROOKE PHYSICAL THERAPIST

Table of content: MARY CATHLEEN BROOKE PHYSICAL THERAPIST (NPI 1003031139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003031139 NPI number — MARY CATHLEEN BROOKE PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROOKE
Provider First Name:
MARY
Provider Middle Name:
CATHLEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DOYLE
Provider Other First Name:
MARY
Provider Other Middle Name:
CATHLEEN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003031139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 LARRABEE AVE
Provider Second Line Business Mailing Address:
STE 104-359
Provider Business Mailing Address City Name:
BELLINGHAM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98225-7367
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-303-1848
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12425 RACE TRACK RD
Provider Second Line Business Practice Location Address:
STE. 100
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33626-3118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-568-9068
Provider Business Practice Location Address Fax Number:
866-360-5916
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1319 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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