Provider Demographics
NPI:1417568395
Name:PENNY, BROOKE (DPT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:PENNY
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 1:303 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-2918
Mailing Address - Country:US
Mailing Address - Phone:903-628-7700
Mailing Address - Fax:903-628-7701
Practice Address - Street 1:303 N CENTER ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-2918
Practice Address - Country:US
Practice Address - Phone:903-628-7700
Practice Address - Fax:903-628-7701
Is Sole Proprietor?:No
Enumeration Date:2020-08-13
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT4826225100000X
1354388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist