Provider Demographics
NPI:1225785074
Name:BROOKS, COURTNEY (PTA)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:BROOKS
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 1:7000 RUNNING BROOK DR
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-5777
Mailing Address - Country:US
Mailing Address - Phone:225-252-4069
Mailing Address - Fax:
Practice Address - Street 1:2500 WOODSIDE DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-1367
Practice Address - Country:US
Practice Address - Phone:817-587-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2163472225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty