Provider Demographics
NPI:1851817993
Name:BROOKS, LAURA M (PTA)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:KRUMANAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:3332 E 400 N
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-9578
Mailing Address - Country:US
Mailing Address - Phone:260-519-1517
Mailing Address - Fax:
Practice Address - Street 1:3720 N NORWOOD RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-8906
Practice Address - Country:US
Practice Address - Phone:260-519-1517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06004274A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant