Provider Demographics
NPI:1003455759
Name:MERINO, BROOKE (DPT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:MERINO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 UPPER OAK DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1731
Mailing Address - Country:US
Mailing Address - Phone:415-793-1088
Mailing Address - Fax:
Practice Address - Street 1:501 VIA CASITAS
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1901
Practice Address - Country:US
Practice Address - Phone:415-546-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-29
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296457225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist