Provider Demographics
NPI:1497145411
Name:KLAWITTER, BROOKE (PTA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:KLAWITTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:MARCOCCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:601 HELENE AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-4009
Mailing Address - Country:US
Mailing Address - Phone:517-420-6453
Mailing Address - Fax:
Practice Address - Street 1:601 HELENE AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-4009
Practice Address - Country:US
Practice Address - Phone:517-420-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502000564225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant