Healthcare Provider Details

I. General information

NPI: 1699111583
Provider Name (Legal Business Name): BROOKE LEIGH WARGA DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 FARSON STREET SUITE 101
BELPRE OH
45714-1067
US

IV. Provider business mailing address

809 FARSON STREET SUITE 101
BELPRE OH
45714-1067
US

V. Phone/Fax

Practice location:
  • Phone: 740-423-1507
  • Fax: 740-401-0660
Mailing address:
  • Phone: 740-423-1507
  • Fax: 740-401-0660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT014197
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: