Provider Demographics
NPI:1275421026
Name:VALLAS, BROOKE ALLISON
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALLISON
Last Name:VALLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ALLISON
Other - Last Name:BATCHELOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 543
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:FL
Mailing Address - Zip Code:32147-0543
Mailing Address - Country:US
Mailing Address - Phone:386-336-3128
Mailing Address - Fax:
Practice Address - Street 1:3253 SW 121ST WAY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-0225
Practice Address - Country:US
Practice Address - Phone:727-457-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist