Provider Demographics
NPI:1336786359
Name:PANNING, BROOKE NICOLE
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE
Last Name:PANNING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:733 SE 50 RD
Mailing Address - Street 2:
Mailing Address - City:ELLINWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:67526-9241
Mailing Address - Country:US
Mailing Address - Phone:620-617-0937
Mailing Address - Fax:
Practice Address - Street 1:510 W 7TH ST
Practice Address - Street 2:
Practice Address - City:ELLINWOOD
Practice Address - State:KS
Practice Address - Zip Code:67526-1101
Practice Address - Country:US
Practice Address - Phone:620-564-2337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-09
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty