Healthcare Provider Details

I. General information

NPI: 1497285449
Provider Name (Legal Business Name): MICHELLE DARLEEN BROOKS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2017
Last Update Date: 06/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 CRESTHAVEN BLVD
WEST PALM BEACH FL
33415-8618
US

IV. Provider business mailing address

5432 54TH WAY
WEST PALM BEACH FL
33409-7109
US

V. Phone/Fax

Practice location:
  • Phone: 561-964-2828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA22042
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: