Provider Demographics
NPI:1306813670
Name:BECKE THOMPSON, BROOKLY JEAN (DPT)
Entity Type:Individual
Prefix:MRS
First Name:BROOKLY
Middle Name:JEAN
Last Name:BECKE THOMPSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 ABERDEEN
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-6187
Mailing Address - Country:US
Mailing Address - Phone:815-238-7218
Mailing Address - Fax:
Practice Address - Street 1:167 ABERDEEN
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-6187
Practice Address - Country:US
Practice Address - Phone:815-238-7218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-04
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
WI9949-024225100000X
IL0700131592251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist