Provider Demographics
NPI:1417182379
Name:BROOKE, ERIKA (LMP)
Entity Type:Individual
Prefix:MS
First Name:ERIKA
Middle Name:
Last Name:BROOKE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12445 110TH LN NE APT Q103
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-9191
Mailing Address - Country:US
Mailing Address - Phone:425-919-4103
Mailing Address - Fax:
Practice Address - Street 1:611 4TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6019
Practice Address - Country:US
Practice Address - Phone:425-919-4103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60081935225700000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist