Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | P17407 |
NPI | 1457728644 |
---|---|
Provider Name | Vanessa Brooks |
First Address | Winston-Salem, NC 27103 |
Second Address | Winston-Salem, NC 27103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2015 |
Last Update Date | 18/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
22 | RESPIRATORY, REHABILITATIVE & RESTORATIVE SERVICE PROVIDERS (01) | GA |