Provider Demographics
NPI:1265444251
Name:WESTBROOK, ROXIE A (PT)
Entity Type:Individual
Prefix:
First Name:ROXIE
Middle Name:A
Last Name:WESTBROOK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 SOQUEL DR
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1716
Mailing Address - Country:US
Mailing Address - Phone:831-476-8778
Mailing Address - Fax:831-476-2815
Practice Address - Street 1:1505 SOQUEL DR
Practice Address - Street 2:SUITE 5A
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1716
Practice Address - Country:US
Practice Address - Phone:831-476-8778
Practice Address - Fax:831-476-2815
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT6750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PT67500Medicare ID - Type Unspecified