MEDICARE: IRENE RILEY BROOKSHER MS, LAT, ATC

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	2255A2300X	Athletic Trainer	327841	LA
2	2255A2300X	Athletic Trainer	AT9190	TX

General Provider Information

NPI Number	:	1033741285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE RILEY BROOKSHER MS, LAT, ATC

Provider Business Mailing Address
First Line	:	3663 WASHINGTON AVE APT 5005
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-6476
Country	:	US
Telephone Number	:	225-773-4896
Fax Number	:

Provider Business Practice Location Address
First Line	:	3663 WASHINGTON AVE APT 5005
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-6476
Country	:	US
Telephone Number	:	225-773-4896
Fax Number	:

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

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	07/24/2024

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