Provider Demographics
NPI:1316563661
Name:WILKE, BROOKE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:WILKE
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 1:2300 JENKS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-5469
Mailing Address - Country:US
Mailing Address - Phone:850-248-1600
Mailing Address - Fax:850-248-1602
Practice Address - Street 1:2300 JENKS AVE STE C
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-5469
Practice Address - Country:US
Practice Address - Phone:850-248-1600
Practice Address - Fax:850-248-1602
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT35857225100000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist