Provider Demographics
NPI:1376031336
Name:TERILLI, BROOKE (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:
Last Name:TERILLI
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 FERN VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577-9788
Mailing Address - Country:US
Mailing Address - Phone:762-338-0227
Mailing Address - Fax:
Practice Address - Street 1:126 PROFESSIONAL DR STE C
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:GA
Practice Address - Zip Code:30511-4013
Practice Address - Country:US
Practice Address - Phone:762-338-0227
Practice Address - Fax:706-608-9013
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT012444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist