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NPI Code Detail

MEDICARE: MR. ERIC KENT BROOKS MA, ATC

MEDICARE: MR. ERIC KENT BROOKS MA, ATC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12255A2300XAthletic TrainerAT-002352OH

General Provider Information

NPI Number : 1487674339
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERIC KENT BROOKS MA, ATC
Provider Business Mailing Address
First Line : 428 GREY STABLE LN
Second Line :
City : HIGHLAND HEIGHTS
State : KY
Zip : 41076-1739
Country : US
Telephone Number : 614-352-7856
Fax Number :
Provider Business Practice Location Address
First Line : 268 AHC, NUNN DR
Second Line :
City : HIGHLAND HEIGHTS
State : KY
Zip : 41099
Country : US
Telephone Number : 859-572-5921
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2006
Last Update Date : 07/08/2007

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