MEDICARE: MRS. BROOKE C THEBEAU PT

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	2006004622	MO

General Provider Information

NPI Number	:	1215251798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BROOKE C THEBEAU PT

Provider Business Mailing Address
First Line	:	11140 THOMPSON AVE
Second Line	:
City	:	LENEXA
State	:	KS
Zip	:	66219-2301
Country	:	US
Telephone Number	:	913-789-4075
Fax Number	:	913-888-1728

Provider Business Practice Location Address
First Line	:	10090 NW PRAIRIE VIEW RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64153-1344
Country	:	US
Telephone Number	:	913-789-4075
Fax Number	:	913-888-1728

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

Provider Enumeration Date	:	03/26/2010
Last Update Date	:	03/26/2010

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