Provider Demographics
NPI:1255408183
Name:BROOKS, BRIAN T (PT)
Entity type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:T
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7201 W CLEARWATER AVE
Mailing Address - Street 2:SUITE B101
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1694
Mailing Address - Country:US
Mailing Address - Phone:509-544-0265
Mailing Address - Fax:509-987-1614
Practice Address - Street 1:1632 W COURT ST
Practice Address - Street 2:
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-3400
Practice Address - Country:US
Practice Address - Phone:509-547-3636
Practice Address - Fax:509-545-5095
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006195225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8335218Medicaid
WA8335218Medicaid