Provider Demographics
NPI:1649085515
Name:BRUCE, BROOKE RAE (LMT)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:RAE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:R
Other - Last Name:SMYKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401
Mailing Address - Country:US
Mailing Address - Phone:701-952-2739
Mailing Address - Fax:
Practice Address - Street 1:805 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401
Practice Address - Country:US
Practice Address - Phone:701-952-2739
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1297225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist