Provider Demographics
NPI:1972646578
Name:BROOKS, KERI KRISTIN (RPT)
Entity Type:Individual
Prefix:MRS
First Name:KERI
Middle Name:KRISTIN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 SANTA BARBARA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-6820
Mailing Address - Country:US
Mailing Address - Phone:352-259-1919
Mailing Address - Fax:
Practice Address - Street 1:1585 SANTA BARBARA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-6820
Practice Address - Country:US
Practice Address - Phone:352-259-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL#19882225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist