Healthcare Provider Details

I. General information

NPI: 1952355778
Provider Name (Legal Business Name): LAURAL LYN BROOKS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SANTA ANA BLVD SUITE 100
SANTA ANA CA
92701-4134
US

IV. Provider business mailing address

1322 TULLY DR
SIDNEY OH
45365-1075
US

V. Phone/Fax

Practice location:
  • Phone: 714-647-0300
  • Fax:
Mailing address:
  • Phone: 949-922-2393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number016599
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: