Provider Demographics
NPI:1790390276
Name:BRINDLE, BROOKE LEE
Entity Type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:LEE
Last Name:BRINDLE
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 1:316 S BELLE RIVER AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:MARINE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48039-3563
Mailing Address - Country:US
Mailing Address - Phone:810-643-3467
Mailing Address - Fax:
Practice Address - Street 1:316 S BELLE RIVER AVE APT 2
Practice Address - Street 2:
Practice Address - City:MARINE CITY
Practice Address - State:MI
Practice Address - Zip Code:48039-3563
Practice Address - Country:US
Practice Address - Phone:810-643-3467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer