Provider Demographics
NPI:1578260378
Name:WHITE, BROOKE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5313 TERAMO LN
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92336-0269
Mailing Address - Country:US
Mailing Address - Phone:626-419-6784
Mailing Address - Fax:
Practice Address - Street 1:1850 N RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8071
Practice Address - Country:US
Practice Address - Phone:909-258-2220
Practice Address - Fax:909-268-2102
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303713225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist