Provider Demographics
NPI:1841716164
Name:ROVILLO, BROOKE BARTON (DPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:BARTON
Last Name:ROVILLO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HAND AVE STE Q
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8196
Mailing Address - Country:US
Mailing Address - Phone:386-673-9880
Mailing Address - Fax:386-673-5841
Practice Address - Street 1:1400 HAND AVE STE Q
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8196
Practice Address - Country:US
Practice Address - Phone:386-673-9880
Practice Address - Fax:386-673-5841
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL32853225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist