Provider Demographics
NPI:1639144066
Name:BROOKS, TOBY JAMES (PHD, ATC, CSCS, PES)
Entity Type:Individual
Prefix:DR
First Name:TOBY
Middle Name:JAMES
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PHD, ATC, CSCS, PES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23893 CARLYLE RD
Mailing Address - Street 2:
Mailing Address - City:THOMPSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62890-2829
Mailing Address - Country:US
Mailing Address - Phone:618-627-2537
Mailing Address - Fax:
Practice Address - Street 1:23893 CARLYLE RD
Practice Address - Street 2:
Practice Address - City:THOMPSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62890-2829
Practice Address - Country:US
Practice Address - Phone:618-627-2537
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer