Provider Demographics
NPI:1033788450
Name:CRUM, BROOKE ALLEGRA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALLEGRA
Last Name:CRUM
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 GOLDFINCH CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3509
Mailing Address - Country:US
Mailing Address - Phone:706-825-3166
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:417 GOLDFINCH CT
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-3509
Practice Address - Country:US
Practice Address - Phone:706-825-3166
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13512225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist