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General NPI Number Information
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NPI Number | 1912345323
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Entity Type | Individual
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Provider Name | BROOKE N PEPPER AT, PTA
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Gender | Female
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Dates
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Enumeration Date | 06/07/2013
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Last Update Date | 06/07/2013
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Provider Practice Location Address
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Address Line | 4850 E MAIN ST
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City | COLUMBUS
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State | OH
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Zip | 43213-3194
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Country | US
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Telephone | 641-566-0929
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Fax |
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Provider Business Mailing Address
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Address Line | 313 TRAIL E
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City | ETNA
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State | OH
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Zip | 43062-9694
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Country | US
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Telephone |
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 08358
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 002761
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License Number State | OH
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