Provider Demographics
NPI:1568002855
Name:MILLER, BROOKE (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 OAKRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-2246
Mailing Address - Country:US
Mailing Address - Phone:469-855-6697
Mailing Address - Fax:
Practice Address - Street 1:402 OAKRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75057-2246
Practice Address - Country:US
Practice Address - Phone:469-855-6697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1227421225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty