Provider Demographics
NPI:1639915077
Name:BROOKOVER, KRISTINE
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:
Last Name:BROOKOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1930 BETHEL MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:HAMERSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45130-9601
Mailing Address - Country:US
Mailing Address - Phone:937-205-8167
Mailing Address - Fax:
Practice Address - Street 1:6201 CLOUGH PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45244-3599
Practice Address - Country:US
Practice Address - Phone:513-813-6592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA013782225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant