Provider Demographics
NPI:1649617820
Name:TRAN, BROOKE ELISE (PT, DPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ELISE
Last Name:TRAN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ELISE
Other - Last Name:BORDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 1557
Mailing Address - Street 2:
Mailing Address - City:BIGFORK
Mailing Address - State:MT
Mailing Address - Zip Code:59911
Mailing Address - Country:US
Mailing Address - Phone:406-837-3255
Mailing Address - Fax:406-837-3256
Practice Address - Street 1:850 HOLT DRIVE
Practice Address - Street 2:
Practice Address - City:BIGFORK
Practice Address - State:MT
Practice Address - Zip Code:59911
Practice Address - Country:US
Practice Address - Phone:406-837-3255
Practice Address - Fax:406-837-3256
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5857225100000X
MTPTP-PT-TMP-5857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist