Provider Demographics
NPI:1821507294
Name:THOMAS, BROOKE ASHLEY (DPT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ASHLEY
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ASHLEY
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:275 PINEHURST AVE SUITE B
Mailing Address - Street 2:
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387
Mailing Address - Country:US
Mailing Address - Phone:910-603-2788
Mailing Address - Fax:888-452-5964
Practice Address - Street 1:275 PINEHURST AVE SUITE B
Practice Address - Street 2:
Practice Address - City:SOUTHERN PINES
Practice Address - State:NC
Practice Address - Zip Code:28387
Practice Address - Country:US
Practice Address - Phone:910-603-2788
Practice Address - Fax:888-452-5964
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH8761225100000X
NCP18961225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist