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General NPI Number Information
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NPI Number | 1003807819
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Entity Type | Individual
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Provider Name | MARK E BROOKS PT, DSC, ECS, OCS
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Gender | Male
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Dates
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Enumeration Date | 11/01/2005
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 312 JASON DR STE 5
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City | RICHMOND
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State | KY
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Zip | 40475-2785
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Country | US
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Telephone | 859-625-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 312 JASON DR STE 5
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City | RICHMOND
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State | KY
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Zip | 40475-2785
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Country | US
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Telephone | 859-625-0001
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Fax | 859-625-1109
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT38134
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 001746
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 2251E1300X
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Taxonomy Name | Clinical Electrophysiology Physical Therapist
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License Number | 001746
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License Number State | KY
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