Provider Demographics
NPI:1720582471
Name:BROOKS, JONAH DEVUAN (LMT)
Entity Type:Individual
Prefix:
First Name:JONAH
Middle Name:DEVUAN
Last Name:BROOKS
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 LOUETTA RD STE B
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7879
Mailing Address - Country:US
Mailing Address - Phone:713-885-2627
Mailing Address - Fax:
Practice Address - Street 1:5521 LOUETTA RD STE B
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7879
Practice Address - Country:US
Practice Address - Phone:713-885-2627
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT110774225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty