Provider Demographics
NPI:1821315813
Name:CORTEZ, BROOKE DOEGEY (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:DOEGEY
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14314 DUSKY THRUSH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-5383
Mailing Address - Country:US
Mailing Address - Phone:210-995-6918
Mailing Address - Fax:
Practice Address - Street 1:14314 DUSKY THRUSH
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-5383
Practice Address - Country:US
Practice Address - Phone:210-995-6918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06122225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist