Healthcare Provider Details

I. General information

NPI: 1457728644
Provider Name (Legal Business Name): VANESSA BROOKS DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VANESSA DOYLEY

II. Dates (important events)

Enumeration Date: 08/24/2015
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MOONEY STREET
WINSTON-SALEM NC
27103
US

IV. Provider business mailing address

1901 MOONEY STREET
WINSTON-SALEM NC
27103
US

V. Phone/Fax

Practice location:
  • Phone: 336-713-6038
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberP17407
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: