Healthcare Provider Details

I. General information

NPI: 1770520629
Provider Name (Legal Business Name): CARLA BROOK HOOPER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 COOK ST SUITE D
MADISONVILLE TN
37354-1508
US

IV. Provider business mailing address

520 COOK ST SUITE D
MADISONVILLE TN
37354-1508
US

V. Phone/Fax

Practice location:
  • Phone: 423-442-1440
  • Fax: 423-442-1441
Mailing address:
  • Phone: 423-442-1440
  • Fax: 423-442-1441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT0000003350
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: