Healthcare Provider Details

I. General information

NPI: 1386256246
Provider Name (Legal Business Name): BROOKE ALYSSA CROSSEN MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W BELTLINE HWY STE 207
MADISON WI
53713-2321
US

IV. Provider business mailing address

2315 TULARE ST
FITCHBURG WI
53711-5672
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-7305
  • Fax:
Mailing address:
  • Phone: 608-957-4134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Y00000X
TaxonomyClinical Exercise Physiologist
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: