Healthcare Provider Details

I. General information

NPI: 1437793866
Provider Name (Legal Business Name): BROOKS HOFER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2019
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12050 SAINT MARYS RD STE C
BROOKVILLE IN
47012-9513
US

IV. Provider business mailing address

12050 SAINT MARYS RD STE C
BROOKVILLE IN
47012-9513
US

V. Phone/Fax

Practice location:
  • Phone: 765-580-2725
  • Fax: 765-230-5003
Mailing address:
  • Phone: 765-580-2725
  • Fax: 765-230-5003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT017662
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05013389A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: