Provider Demographics
NPI:1700033594
Name:DARST RICE, BROOKE NOELLE (PT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:NOELLE
Last Name:DARST RICE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 MAIN ST SE STE 223
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-1032
Mailing Address - Country:US
Mailing Address - Phone:612-331-5757
Mailing Address - Fax:612-331-7557
Practice Address - Street 1:43 MAIN ST SE STE 223
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-1032
Practice Address - Country:US
Practice Address - Phone:612-331-5757
Practice Address - Fax:612-331-7557
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8175174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist