Healthcare Provider Details

I. General information

NPI: 1235852658
Provider Name (Legal Business Name): BROOKE ALEXANDRA MERRILL-SMITH PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BROOKE ALEXANDRA MERRILL PT, DPT

II. Dates (important events)

Enumeration Date: 09/21/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8250 N CHURCH RD STE B
KANSAS CITY MO
64158-1103
US

IV. Provider business mailing address

742 MISSION HTS
NEW BRAUNFELS TX
78130-6038
US

V. Phone/Fax

Practice location:
  • Phone: 816-792-0524
  • Fax:
Mailing address:
  • Phone: 757-969-0775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1368776
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP057812T
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: