Provider Demographics
NPI:1760400378
Name:FARRY, BROOKS (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:BROOKS
Middle Name:
Last Name:FARRY
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BRANDLEY RD
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2217
Mailing Address - Country:US
Mailing Address - Phone:781-891-2062
Mailing Address - Fax:
Practice Address - Street 1:175 FOREST STREET
Practice Address - Street 2:ATHLETIC TRAINING DEPARTMENT
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452
Practice Address - Country:US
Practice Address - Phone:781-891-2062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4032255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer