Provider Demographics
NPI:1073535464
Name:ADAME-BROOKS, THERESA J (PT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:J
Last Name:ADAME-BROOKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:J
Other - Last Name:ADAME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1545 E SOUTHLAKE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-6465
Mailing Address - Country:US
Mailing Address - Phone:817-442-9300
Mailing Address - Fax:817-416-0108
Practice Address - Street 1:1545 E SOUTHLAKE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6465
Practice Address - Country:US
Practice Address - Phone:817-442-9300
Practice Address - Fax:817-416-0108
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1095495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist