Provider Demographics
NPI:1225423825
Name:ELMORE, BROOKE MIRANDA (PT,DPT,CLT)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:MIRANDA
Last Name:ELMORE
Suffix:
Gender:F
Credentials:PT,DPT,CLT
Other - Prefix:DR
Other - First Name:BROOKE
Other - Middle Name:MIRANDA
Other - Last Name:WOMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:15 FLOWERING APRICOT DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6362
Mailing Address - Country:US
Mailing Address - Phone:919-885-9135
Mailing Address - Fax:
Practice Address - Street 1:7417 KNIGHTDALE BLVD
Practice Address - Street 2:SUITE # 103
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-8824
Practice Address - Country:US
Practice Address - Phone:919-217-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VACP015690T225X00000X
NCP14582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist