Provider Demographics
NPI:1669604013
Name:VANDENHOEK, BROOKE DANIELLE (PT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:DANIELLE
Last Name:VANDENHOEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:DANIELLE
Other - Last Name:LARSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MN
Practice Address - Zip Code:56110-1051
Practice Address - Country:US
Practice Address - Phone:507-483-2668
Practice Address - Fax:507-483-2925
Is Sole Proprietor?:No
Enumeration Date:2009-08-19
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8107225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN650002269Medicare PIN