Provider Demographics
NPI:1750086443
Name:CULP, BROOKE MARIE (PTA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:MARIE
Last Name:CULP
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9354 LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9169
Mailing Address - Country:US
Mailing Address - Phone:567-712-0994
Mailing Address - Fax:
Practice Address - Street 1:3760 ALLENTOWN RD
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45807-2140
Practice Address - Country:US
Practice Address - Phone:419-221-0904
Practice Address - Fax:419-221-3018
Is Sole Proprietor?:No
Enumeration Date:2023-04-03
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA012358225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant