Provider Demographics
NPI:1508278839
Name:BROOKS, COURTNEY (PT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:
Other - Last Name:HOLLUMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2525 N GRANDVIEW AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-1621
Mailing Address - Country:US
Mailing Address - Phone:432-550-4700
Mailing Address - Fax:
Practice Address - Street 1:2525 N GRANDVIEW AVE STE 400
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-1621
Practice Address - Country:US
Practice Address - Phone:432-550-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3115098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8TAE47OtherBCBSTX
TX406074YLJGMedicare UPIN