Healthcare Provider Details

I. General information

NPI: 1104583467
Provider Name (Legal Business Name): BROOKE TAYLOR DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11825 MAJOR ST STE 107
CULVER CITY CA
90230-6356
US

IV. Provider business mailing address

507 HILLCREST ST
EL SEGUNDO CA
90245-2959
US

V. Phone/Fax

Practice location:
  • Phone: 310-915-6100
  • Fax:
Mailing address:
  • Phone: 310-947-2543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number301325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: