Provider Demographics
NPI:1881907657
Name:WINDER, BROOKE RENEE (PT)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:RENEE
Last Name:WINDER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5744 E CREEKSIDE AVE UNIT 41
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92869-3146
Mailing Address - Country:US
Mailing Address - Phone:657-221-5401
Mailing Address - Fax:
Practice Address - Street 1:5744 E CREEKSIDE AVE UNIT 41
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-3146
Practice Address - Country:US
Practice Address - Phone:657-221-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36874225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist