Provider Demographics
NPI:1982973087
Name:BROOKES, ROB ALAN (ATC)
Entity Type:Individual
Prefix:
First Name:ROB
Middle Name:ALAN
Last Name:BROOKES
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6604 STATE HIGHWAY 56
Mailing Address - Street 2:APT #3
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-3545
Mailing Address - Country:US
Mailing Address - Phone:315-244-4447
Mailing Address - Fax:
Practice Address - Street 1:6604 STATE HIGHWAY 56
Practice Address - Street 2:APT #3
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-3545
Practice Address - Country:US
Practice Address - Phone:315-244-4447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY670020352255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer