Provider Demographics
NPI:1235852658
Name:MERRILL, BROOKE ALEXANDRA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALEXANDRA
Last Name:MERRILL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9075 GAYLORD DR APT 53
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-2955
Mailing Address - Country:US
Mailing Address - Phone:757-969-0775
Mailing Address - Fax:
Practice Address - Street 1:209 E ROGERS BLVD
Practice Address - Street 2:
Practice Address - City:SKIATOOK
Practice Address - State:OK
Practice Address - Zip Code:74070-1251
Practice Address - Country:US
Practice Address - Phone:918-396-9799
Practice Address - Fax:918-396-9891
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1368776225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist