Provider Demographics
NPI:1417239906
Name:MCADAM, BROOKE MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MARIE
Last Name:MCADAM
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 ROTHBURY CIR
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1417
Mailing Address - Country:US
Mailing Address - Phone:585-259-6164
Mailing Address - Fax:
Practice Address - Street 1:4 ROTHBURY CIR
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1417
Practice Address - Country:US
Practice Address - Phone:585-259-6164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033951225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY033951OtherPHYSICAL THERAPY LICENSE