Provider Demographics
NPI:1881318871
Name:BECHTOLD, BROOKE ANNALYNN
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ANNALYNN
Last Name:BECHTOLD
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 1:16953 172ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:BIG LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55309-4582
Mailing Address - Country:US
Mailing Address - Phone:763-688-0009
Mailing Address - Fax:
Practice Address - Street 1:2155 POST OAK TRITT RD STE 400
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-1651
Practice Address - Country:US
Practice Address - Phone:678-401-2952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA25562251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic