Provider Demographics
NPI:1447797626
Name:DEWITT, BROOKE (PTA)
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:
Last Name:DEWITT
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 NORTHLINE AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7616
Mailing Address - Country:US
Mailing Address - Phone:336-545-5000
Mailing Address - Fax:
Practice Address - Street 1:3200 NORTHLINE AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7616
Practice Address - Country:US
Practice Address - Phone:336-545-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA5007225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant