Provider Demographics
NPI:1396903316
Name:WALDROUP-COATS, BROOKE (LPTA)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:
Last Name:WALDROUP-COATS
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 HOLCOMBE COVE RD
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-9450
Mailing Address - Country:US
Mailing Address - Phone:828-667-9851
Mailing Address - Fax:
Practice Address - Street 1:95 HOLCOMBE COVE RD
Practice Address - Street 2:
Practice Address - City:CANDLER
Practice Address - State:NC
Practice Address - Zip Code:28715-9450
Practice Address - Country:US
Practice Address - Phone:828-667-9851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3670225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant