Provider Demographics
NPI:1407001597
Name:BROOKS, JOANNE (MS,PT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:JOANNE
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,PT
Mailing Address - Street 1:21 BIRCH LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-1703
Mailing Address - Country:US
Mailing Address - Phone:718-619-1874
Mailing Address - Fax:718-984-0125
Practice Address - Street 1:329 NORWAY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3524
Practice Address - Country:US
Practice Address - Phone:718-987-9400
Practice Address - Fax:718-987-4766
Is Sole Proprietor?:No
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist