Provider Demographics
NPI:1275985020
Name:BROOKS, MARLA
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 FRANCE AVE S STE 260
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1816
Mailing Address - Country:US
Mailing Address - Phone:952-922-0330
Mailing Address - Fax:952-922-0990
Practice Address - Street 1:6600 FRANCE AVE S STE 260
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-1816
Practice Address - Country:US
Practice Address - Phone:952-922-0330
Practice Address - Fax:952-922-0990
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102682251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic