Provider Demographics
NPI:1659106953
Name:WIEST, BROOKE HACKMEIER (MSPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:HACKMEIER
Last Name:WIEST
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:
Other - Last Name:HACKMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSPT
Mailing Address - Street 1:816 E WOODSTONE CIR
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-9359
Mailing Address - Country:US
Mailing Address - Phone:303-638-4401
Mailing Address - Fax:
Practice Address - Street 1:929 N SAINT FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-07686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist