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General NPI Number Information
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NPI Number | 1184597122
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Entity Type | Individual
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Provider Name | BROOKE SOUTHARD PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 214 18TH ST SE
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City | HICKORY
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State | NC
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Zip | 28602-1363
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Country | US
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Telephone | 828-485-2160
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 40
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City | PUNGOTEAGUE
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State | VA
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Zip | 23422-0040
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Country | US
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Telephone | 703-473-8207
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Fax |
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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 | 2305217416
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License Number State | VA
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