Provider Demographics
NPI:1033005426
Name:GRIMES, BROOKE MAKENZIE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:MAKENZIE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 N COLEMAN ST STE 160
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-2306
Mailing Address - Country:US
Mailing Address - Phone:972-347-1111
Mailing Address - Fax:
Practice Address - Street 1:821 N COLEMAN ST STE 160
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2306
Practice Address - Country:US
Practice Address - Phone:972-347-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4063856225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant