Provider Demographics
NPI:1245475227
Name:BROOKS, AMANDA JEAN (DPT)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JEAN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 S TRIMBLE RD
Mailing Address - Street 2:ATTN: CREDENTIALS
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-3427
Mailing Address - Country:US
Mailing Address - Phone:419-529-6323
Mailing Address - Fax:419-529-6318
Practice Address - Street 1:1025 S TRIMBLE RD
Practice Address - Street 2:ATTN: CREDENTIALS
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-3427
Practice Address - Country:US
Practice Address - Phone:419-529-6323
Practice Address - Fax:419-529-6318
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 012249225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVAD000Medicare UPIN