Provider Demographics
NPI:1326357674
Name:BROOKS, JANET SUE (PT)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:SUE
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4810 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-1748
Mailing Address - Country:US
Mailing Address - Phone:913-321-4567
Mailing Address - Fax:913-321-6789
Practice Address - Street 1:4810 STATE AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-1748
Practice Address - Country:US
Practice Address - Phone:913-321-4567
Practice Address - Fax:913-321-6789
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO00520225100000X
KS03383225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist