Provider Demographics
NPI:1952686362
Name:BRIGGS, BROOKE ANN (LMP)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANN
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:WA
Mailing Address - Zip Code:98531-2735
Mailing Address - Country:US
Mailing Address - Phone:360-508-3450
Mailing Address - Fax:
Practice Address - Street 1:1270 SW WILLIAM AVE
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-4730
Practice Address - Country:US
Practice Address - Phone:360-748-8814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60251406225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist