Provider Demographics
NPI:1902231400
Name:BROOKS, ORIE O (PTA)
Entity Type:Individual
Prefix:
First Name:ORIE
Middle Name:O
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:200 W DOUGLAS AVE
Mailing Address - Street 2:STE 1040
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-3013
Mailing Address - Country:US
Mailing Address - Phone:316-263-0003
Mailing Address - Fax:316-263-1241
Practice Address - Street 1:4515 E CENTRAL AVE
Practice Address - Street 2:STE A
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3915
Practice Address - Country:US
Practice Address - Phone:316-260-6869
Practice Address - Fax:316-260-6872
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS1402580225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant