Provider Demographics
NPI:1649048992
Name:BROOKS, ALYSSA TAYLOR (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:TAYLOR
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 PEPPERVINE AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-5275
Mailing Address - Country:US
Mailing Address - Phone:904-238-3711
Mailing Address - Fax:
Practice Address - Street 1:17430 N PORTER RD
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-4789
Practice Address - Country:US
Practice Address - Phone:520-208-2033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-15
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41157225100000X
TX1390961225100000X
AZLPT-033872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist