Provider Demographics
NPI:1689008153
Name:NORBECK, BROOKE ANNE (DPT)
Entity Type:Individual
Prefix:MS
First Name:BROOKE
Middle Name:ANNE
Last Name:NORBECK
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 1:19252 ROAD 21
Mailing Address - Street 2:
Mailing Address - City:FORT JENNINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45844-9120
Mailing Address - Country:US
Mailing Address - Phone:567-204-1553
Mailing Address - Fax:
Practice Address - Street 1:1012 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2445
Practice Address - Country:US
Practice Address - Phone:567-204-1553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-02
Last Update Date:2013-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT.0012364225100000X
OHPT.014454225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist