Provider Demographics
NPI:1407526064
Name:BROOKS, SHAINA (MT)
Entity Type:Individual
Prefix:
First Name:SHAINA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 133
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-0133
Mailing Address - Country:US
Mailing Address - Phone:404-717-9978
Mailing Address - Fax:
Practice Address - Street 1:66 UPPER MAIN ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:VT
Practice Address - Zip Code:05661-6600
Practice Address - Country:US
Practice Address - Phone:404-717-9978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTLI-456675225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty