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General NPI Number Information
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NPI Number | 1497068712
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Entity Type | Individual
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Provider Name | BROOKE SUZANNE REY ATC, LAT
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Gender | Female
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Dates
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Enumeration Date | 07/15/2010
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Last Update Date | 04/18/2014
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Provider Practice Location Address
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Address Line | 300 NORTH COLLEGE ROAD WEST
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City | TWIN FALLS
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State | ID
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Zip | 83301-5029
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Country | US
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Telephone | 208-732-7555
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 STARFIRE STREET
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City | TWIN FALLS
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State | ID
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Zip | 83301-5029
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Country | US
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Telephone | 208-340-0831
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Fax | 208-732-7556
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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-366
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License Number State | ID
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