Provider Demographics
NPI:1871237289
Name:WEBB, BROOKLYN SARAH
Entity Type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:SARAH
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1624 E SELTICE WAY
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-7022
Mailing Address - Country:US
Mailing Address - Phone:208-818-3290
Mailing Address - Fax:208-773-7300
Practice Address - Street 1:1624 E SELTICE WAY
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-7022
Practice Address - Country:US
Practice Address - Phone:208-777-0128
Practice Address - Fax:208-773-9600
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMAS3273225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist