Provider Demographics
NPI:1114699279
Name:BROOKMAN, MERIBETH (PTA)
Entity Type:Individual
Prefix:
First Name:MERIBETH
Middle Name:
Last Name:BROOKMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 WASHINGTON VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-7170
Mailing Address - Country:US
Mailing Address - Phone:908-741-8404
Mailing Address - Fax:908-741-8406
Practice Address - Street 1:125 WASHINGTON VALLEY RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-7170
Practice Address - Country:US
Practice Address - Phone:908-741-8404
Practice Address - Fax:908-741-8406
Is Sole Proprietor?:No
Enumeration Date:2021-09-28
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QB00387000225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant