Provider Demographics
NPI:1265835730
Name:LERMA, BROOKE LAUREN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:LAUREN
Last Name:LERMA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 5TH ST
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:IA
Mailing Address - Zip Code:52747-9622
Mailing Address - Country:US
Mailing Address - Phone:563-785-8070
Mailing Address - Fax:563-785-8055
Practice Address - Street 1:210 5TH ST
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:IA
Practice Address - Zip Code:52747-9622
Practice Address - Country:US
Practice Address - Phone:563-785-8070
Practice Address - Fax:563-785-8055
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA006637225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist