Provider Demographics
NPI:1649836370
Name:ANZALONE, BROOKE
Entity type:Individual
Prefix:MISS
First Name:BROOKE
Middle Name:
Last Name:ANZALONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 80480
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70596-0480
Mailing Address - Country:US
Mailing Address - Phone:337-981-9940
Mailing Address - Fax:337-981-2531
Practice Address - Street 1:227 B BENDEL RD
Practice Address - Street 2:SUITE C
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70503
Practice Address - Country:US
Practice Address - Phone:337-981-9940
Practice Address - Fax:337-981-2531
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA10037225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist