Provider Demographics
NPI:1023443124
Name:SHOCKLEY, BROOKE POWERS (PTA)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:POWERS
Last Name:SHOCKLEY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2622 HENDERSON ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28638-9131
Mailing Address - Country:US
Mailing Address - Phone:828-514-5643
Mailing Address - Fax:
Practice Address - Street 1:2030 HARPER AVE NW
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-4953
Practice Address - Country:US
Practice Address - Phone:828-754-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-08
Last Update Date:2013-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5149225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant