Provider Demographics
NPI:1760768915
Name:BROOKS, AMBER DAY
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:DAY
Last Name:BROOKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:ISLAND POND
Mailing Address - State:VT
Mailing Address - Zip Code:05846-0563
Mailing Address - Country:US
Mailing Address - Phone:802-673-2820
Mailing Address - Fax:
Practice Address - Street 1:35 BEL AIRE DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-4953
Practice Address - Country:US
Practice Address - Phone:802-673-2820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-01
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0410000341225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant