Provider Demographics
NPI:1558071944
Name:BROOKS, DUSTIN ARNOLD (MSPO, LPO, CPO)
Entity type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:ARNOLD
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MSPO, LPO, CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 W SAND LAKE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-5280
Mailing Address - Country:US
Mailing Address - Phone:321-247-5151
Mailing Address - Fax:321-666-7643
Practice Address - Street 1:7345 W SAND LAKE RD STE 220
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-5280
Practice Address - Country:US
Practice Address - Phone:321-247-5151
Practice Address - Fax:321-666-7643
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOR247222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist