Healthcare Provider Details

I. General information

NPI: 1720856487
Provider Name (Legal Business Name): BROOKE ZUKOWSKI PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2023
Last Update Date: 12/12/2023
Certification Date: 12/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 W BROADWAY STE 105
COLUMBIA MO
65203-1136
US

IV. Provider business mailing address

3503 BRIARMONT AVE APT 310
COLUMBIA MO
65201-3698
US

V. Phone/Fax

Practice location:
  • Phone: 724-814-2280
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2023047492
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: