Provider Demographics
NPI:1245501220
Name:BROOK, ERICA BEA (PT)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:BEA
Last Name:BROOK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10715 NE 37TH CT APT 129
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-1703
Mailing Address - Country:US
Mailing Address - Phone:559-392-8595
Mailing Address - Fax:
Practice Address - Street 1:10715 NE 37TH CT APT 129
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-1703
Practice Address - Country:US
Practice Address - Phone:559-392-8595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 38622225100000X
WAPT60592722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAPT60592722OtherPHYSICAL THERAPIST
CAPT38622OtherPHYSICAL THERAPIST