Provider Demographics
NPI:1912625229
Name:WILLIAMSON, BROOKE (LMT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:WILLIAMSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7364 W OHIO AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-4984
Mailing Address - Country:US
Mailing Address - Phone:425-971-7988
Mailing Address - Fax:
Practice Address - Street 1:7364 W OHIO AVE APT 204
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-4984
Practice Address - Country:US
Practice Address - Phone:425-971-7988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0025097225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist