Provider Demographics
NPI:1346981974
Name:BARAK, BROOKE (MT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:BARAK
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12619 NE 45TH CIR
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-6445
Mailing Address - Country:US
Mailing Address - Phone:360-553-1153
Mailing Address - Fax:
Practice Address - Street 1:13317 NE 12TH AVE STE 115
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2731
Practice Address - Country:US
Practice Address - Phone:360-553-1153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA61277417225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist