Provider Demographics
NPI:1003031139
Name:BROOKE, MARY CATHLEEN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHLEEN
Last Name:BROOKE
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CATHLEEN
Other - Last Name:DOYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1050 LARRABEE AVE
Mailing Address - Street 2:STE 104-359
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-7367
Mailing Address - Country:US
Mailing Address - Phone:360-303-1848
Mailing Address - Fax:
Practice Address - Street 1:12425 RACE TRACK RD
Practice Address - Street 2:STE. 100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3118
Practice Address - Country:US
Practice Address - Phone:866-568-9068
Practice Address - Fax:866-360-5916
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist