Healthcare Provider Details

I. General information

NPI: 1316184062
Provider Name (Legal Business Name): BROOKE ALISON FIELDS DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2009
Last Update Date: 01/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 INTERNATIONAL PKWY SUITE 260
LAKE MARY FL
32746-5030
US

IV. Provider business mailing address

1595 KING AVE
TIPTON IA
52772-9236
US

V. Phone/Fax

Practice location:
  • Phone: 800-806-6026
  • Fax:
Mailing address:
  • Phone: 563-212-2477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1186100
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: