Provider Demographics
NPI:1043401169
Name:BROOKS, DIANA W (DPT)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:W
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:M
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 69030
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-9030
Mailing Address - Country:US
Mailing Address - Phone:757-873-2302
Mailing Address - Fax:757-873-2306
Practice Address - Street 1:10400 IRON BRIDGE RD
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1427
Practice Address - Country:US
Practice Address - Phone:804-796-1518
Practice Address - Fax:804-796-1543
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205128225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043401169Medicaid
VAP00412008OtherRAILROAD MEDICARE
VA192935OtherBCBS (PHYSICAL THERAPY)
VA7048994OtherAETNA
VA192935OtherBCBS (PHYSICAL THERAPY)
VA1043401169Medicaid