Healthcare Provider Details

I. General information

NPI: 1225706153
Provider Name (Legal Business Name): BROOKE ROSE COOPER PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE ROSE IRELAND PT, DPT

II. Dates (important events)

Enumeration Date: 09/03/2021
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2822 JACKSON BLVD STE 202
RAPID CITY SD
57702-3497
US

IV. Provider business mailing address

511 NATIONAL ST STE 104
BELLE FOURCHE SD
57717-1813
US

V. Phone/Fax

Practice location:
  • Phone: 605-503-7080
  • Fax: 605-503-7081
Mailing address:
  • Phone: 605-723-0185
  • Fax: 605-723-0186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-5284
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberCP043999T
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number14695
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6038
License Number StateSD
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2022009472
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number65060
License Number StateOR
# 7
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateOR
# 8
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1347568
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: