Provider Demographics
NPI:1467717868
Name:GREEN, BROOKE LOVE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:LOVE
Last Name:GREEN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:JEAN
Other - Last Name:LOVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:856-677-4000
Mailing Address - Fax:856-234-3014
Practice Address - Street 1:1075 VIRGINIA DR STE 200
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3108
Practice Address - Country:US
Practice Address - Phone:215-717-8463
Practice Address - Fax:215-619-4555
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT025214225100000X
VT0400086262225100000X
AZLPT-010681225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist