Healthcare Provider Details

I. General information

NPI: 1033788450
Provider Name (Legal Business Name): BROOKE ALLEGRA CRUM PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2021
Last Update Date: 06/21/2021
Certification Date: 06/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 GOLDFINCH CT
AUGUSTA GA
30907-3509
US

IV. Provider business mailing address

417 GOLDFINCH CT
AUGUSTA GA
30907-3509
US

V. Phone/Fax

Practice location:
  • Phone: 706-825-3166
  • Fax: 855-232-8604
Mailing address:
  • Phone: 706-825-3166
  • Fax: 855-232-8604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number13512
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: