Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 1319 | AZ |
NPI | 1003031139 |
---|---|
Provider Name | Mary Cathleen Brooke |
First Address | Bellingham, WA 98225-7367 |
Second Address | Tampa, FL 33626-3118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2007 |
Last Update Date | 08/07/2007 |