MEDICARE: MARK E BROOKS PT, DSC, ECS, OCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT38134	FL
2	225100000X	Physical Therapist	001746	KY
3	2251E1300X	Clinical Electrophysiology Physical Therapist	001746	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000215122	OTHER	KY	BC/BS SPTA
2	000000310944	OTHER	KY	BC/BS RPTA
3	000000060027	OTHER	KY	BC/BS LPTA
4	000000333709	OTHER	KY	BC/BS HPTA
5	611208897	OTHER	KY	HUMANA
6	611208897	OTHER	KY	BLUEGRASS FAMILY
7	611208897	OTHER	KY	WORKERS COMP.
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	611208897	OTHER	KY	AETNA
10	611208897	OTHER	KY	TRICARE

General Provider Information

NPI Number	:	1003807819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK E BROOKS PT, DSC, ECS, OCS

Provider Business Mailing Address
First Line	:	312 JASON DR STE 5
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2785
Country	:	US
Telephone Number	:	859-625-0001
Fax Number	:	859-625-1109

Provider Business Practice Location Address
First Line	:	312 JASON DR STE 5
Second Line	:
City	:	RICHMOND
State	:	KY
Zip	:	40475-2785
Country	:	US
Telephone Number	:	859-625-0001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	12/02/2025

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Directions to “ MARK E BROOKS PT, DSC, ECS, OCS” Practice Location

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