Healthcare Provider Details

I. General information

NPI: 1316563661
Provider Name (Legal Business Name): BROOKE WILKE ZINN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2020
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11010 DAVID ST # A
GULFPORT MS
39503-3481
US

IV. Provider business mailing address

11010 DAVID ST # A
GULFPORT MS
39503-3481
US

V. Phone/Fax

Practice location:
  • Phone: 228-832-8327
  • Fax:
Mailing address:
  • Phone: 228-832-8327
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPT35857
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT35857
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT8041
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: