Healthcare Provider Details

I. General information

NPI: 1255268702
Provider Name (Legal Business Name): RUTH BROOKS PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 MIXON LN
MANCHESTER TN
37355-4931
US

IV. Provider business mailing address

218 MIXON LN
MANCHESTER TN
37355-4931
US

V. Phone/Fax

Practice location:
  • Phone: 931-434-9283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number8798
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: