Provider Demographics
NPI:1184298432
Name:BROOKS, CLINT WILLIAM (DPT)
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:WILLIAM
Last Name:BROOKS
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:630-575-1980
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:8270 S HOUGHTON RD STE 180
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9717
Practice Address - Country:US
Practice Address - Phone:520-664-1430
Practice Address - Fax:520-664-1431
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-19
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214310225100000X
AZCP042420T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist