Provider Demographics
NPI:1205269354
Name:HUGHES, BROOKE GLORIA (ATC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:GLORIA
Last Name:HUGHES
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 23RD ST STE 15
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-3161
Mailing Address - Country:US
Mailing Address - Phone:402-562-4607
Mailing Address - Fax:
Practice Address - Street 1:3100 23RD ST STE 15
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-3161
Practice Address - Country:US
Practice Address - Phone:402-562-4607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5752255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer