Provider Demographics
NPI:1982291605
Name:REYERSON, BROOKE (MS,LAT,ATC)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:REYERSON
Suffix:
Gender:F
Credentials:MS,LAT,ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 3RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-5420
Mailing Address - Country:US
Mailing Address - Phone:605-226-5500
Mailing Address - Fax:
Practice Address - Street 1:1200 S JAY ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-7198
Practice Address - Country:US
Practice Address - Phone:507-402-7233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD06042081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine