Provider Demographics
NPI:1659757987
Name:LAUBE, BROOKLYN MARIE (DPT)
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:MARIE
Last Name:LAUBE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 OAKLEAF WAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2245
Mailing Address - Country:US
Mailing Address - Phone:715-839-9266
Mailing Address - Fax:
Practice Address - Street 1:1200 OAKLEAF WAY
Practice Address - Street 2:SUITE B
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720-2245
Practice Address - Country:US
Practice Address - Phone:715-839-9266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-10
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13128-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI13158OtherPHYSICAL THERAPY LICENSE