Healthcare Provider Details

I. General information

NPI: 1881902625
Provider Name (Legal Business Name): BROOK ETCHIESON ELLENBRAND DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 N TYLER ST
LITTLE ROCK AR
72205-3535
US

IV. Provider business mailing address

2624 CROUCHWOOD RD
LITTLE ROCK AR
72207-2643
US

V. Phone/Fax

Practice location:
  • Phone: 501-664-2961
  • Fax:
Mailing address:
  • Phone: 501-681-3475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT3271
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: