Provider Demographics
NPI:1831654540
Name:WILTSHIRE, BROOKE BURGE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:BURGE
Last Name:WILTSHIRE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10205 US 15 501 HWY UNIT 26
Mailing Address - Street 2:#173
Mailing Address - City:SOUTHERN PINES
Mailing Address - State:NC
Mailing Address - Zip Code:28387-5180
Mailing Address - Country:US
Mailing Address - Phone:315-783-6954
Mailing Address - Fax:
Practice Address - Street 1:155 ALLISON PAGE RD
Practice Address - Street 2:SUITE B
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315
Practice Address - Country:US
Practice Address - Phone:910-227-9194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-06
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18609225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist