Provider Demographics
NPI:1811232192
Name:NEAULT, BROOKE (BCMT, CMT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:NEAULT
Suffix:
Gender:F
Credentials:BCMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 HARRIS STREET
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901
Mailing Address - Country:US
Mailing Address - Phone:530-933-9123
Mailing Address - Fax:
Practice Address - Street 1:145 BALBOA ST APT 103
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-4049
Practice Address - Country:US
Practice Address - Phone:530-933-9123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-28
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT570492-09225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist