Healthcare Provider Details

I. General information

NPI: 1689089450
Provider Name (Legal Business Name): BETH BROOKS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4611 TRUEMAN BLVD
HILLIARD OH
43026-2485
US

IV. Provider business mailing address

170 TAYLOR STATION RD
COLUMBUS OH
43213-4491
US

V. Phone/Fax

Practice location:
  • Phone: 614-340-0683
  • Fax: 614-488-0390
Mailing address:
  • Phone: 614-545-7900
  • Fax: 614-545-7901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT.009030
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: