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General NPI Number Information
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NPI Number | 1487674339
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Entity Type | Individual
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Provider Name | ERIC KENT BROOKS MA, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 268 AHC, NUNN DR
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City | HIGHLAND HEIGHTS
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State | KY
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Zip | 41099
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Country | US
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Telephone | 859-572-5921
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Fax |
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Provider Business Mailing Address
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Address Line | 428 GREY STABLE LN
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City | HIGHLAND HEIGHTS
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State | KY
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Zip | 41076-1739
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Country | US
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Telephone | 614-352-7856
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT-002352
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License Number State | OH
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