Provider Demographics
NPI:1932208071
Name:LOUCKS, BROOKE W (DPT)
Entity Type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:W
Last Name:LOUCKS
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 1:158 NORTH 1ST STREET
Mailing Address - Street 2:SUITE D
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625
Mailing Address - Country:US
Mailing Address - Phone:989-539-4167
Mailing Address - Fax:989-539-4436
Practice Address - Street 1:158 NORTH 1ST STREET
Practice Address - Street 2:SUITE D
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625
Practice Address - Country:US
Practice Address - Phone:989-539-4167
Practice Address - Fax:989-539-4436
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012984225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist