Provider Demographics
NPI:1124628979
Name:BROOKS, CASEY (LAT, ATC)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PINEHURST DR APT E
Mailing Address - Street 2:
Mailing Address - City:ALBERTVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35951-7471
Mailing Address - Country:US
Mailing Address - Phone:256-899-3430
Mailing Address - Fax:
Practice Address - Street 1:220 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-1650
Practice Address - Country:US
Practice Address - Phone:256-899-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-30
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN27222255A2300X
AL27692255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer