Provider Demographics
NPI:1114637576
Name:VINITSKI, BROOKE ANN (DPT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANN
Last Name:VINITSKI
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 1:337 WERNER ST
Mailing Address - Street 2:
Mailing Address - City:WERNERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19565-1907
Mailing Address - Country:US
Mailing Address - Phone:484-651-4030
Mailing Address - Fax:
Practice Address - Street 1:2211 QUARRY DR STE E55
Practice Address - Street 2:
Practice Address - City:WEST LAWN
Practice Address - State:PA
Practice Address - Zip Code:19609-1162
Practice Address - Country:US
Practice Address - Phone:610-860-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT030534225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist