Provider Demographics
NPI:1609918481
Name:BROOKS, THOMAS JOSEPH (LMP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 78193
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-0193
Mailing Address - Country:US
Mailing Address - Phone:206-772-5315
Mailing Address - Fax:206-774-8751
Practice Address - Street 1:2366 EASTLAKE AVE E STE 407
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3394
Practice Address - Country:US
Practice Address - Phone:206-621-8834
Practice Address - Fax:206-860-9700
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABR0710Medicare UPIN
WA0063953Medicare UPIN