Provider Demographics
NPI:1790074821
Name:BROOKS, STEVEN MATTHEW (PT)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:MATTHEW
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 ROLFE SQ
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02910-2802
Mailing Address - Country:US
Mailing Address - Phone:401-725-8400
Mailing Address - Fax:401-725-8402
Practice Address - Street 1:30 ROLFE SQ
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02910-2802
Practice Address - Country:US
Practice Address - Phone:401-725-8400
Practice Address - Fax:401-725-8402
Is Sole Proprietor?:No
Enumeration Date:2011-03-29
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT01523225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist