Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 011612-1 | NY |
Y | 2251P0200X | Physical Therapist - Pediatrics | 011612-1 | NY |
NPI | 1093965253 |
---|---|
Provider Name | Diana L. Brooks |
First Address | Red Hook, NY 12571-1122 |
Second Address | Red Hook, NY 12571-1122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2008 |
Last Update Date | 24/09/2008 |