Provider Demographics
NPI:1467003418
Name:JANES, BROOKE N (PTA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:N
Last Name:JANES
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 1:577 E 200 S
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872-7041
Mailing Address - Country:US
Mailing Address - Phone:765-562-3020
Mailing Address - Fax:
Practice Address - Street 1:375 S 11TH ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IN
Practice Address - Zip Code:47842-1053
Practice Address - Country:US
Practice Address - Phone:765-832-2491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-21
Last Update Date:2019-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004353A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant