Provider Demographics
NPI:1023683919
Name:PRIDGEON, BROOKE ALYSSA (PT, DPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ALYSSA
Last Name:PRIDGEON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 HAMLET PL S
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-1591
Mailing Address - Country:US
Mailing Address - Phone:410-652-3917
Mailing Address - Fax:
Practice Address - Street 1:700 JOHN RINGLING BLVD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-1542
Practice Address - Country:US
Practice Address - Phone:844-334-3818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37077208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation