Provider Demographics
NPI:1780635698
Name:BROOKS, NANCY JOAN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:JOAN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6639 LAWNWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3614
Mailing Address - Country:US
Mailing Address - Phone:440-888-7761
Mailing Address - Fax:
Practice Address - Street 1:15435 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-4827
Practice Address - Country:US
Practice Address - Phone:440-887-6000
Practice Address - Fax:440-887-6000
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH051225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant