MEDICARE: BROOKE MCCALL

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	11808	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770066011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BROOKE MCCALL

Provider Business Mailing Address
First Line	:	PO BOX 681478
Second Line	:
City	:	FRANKLIN
State	:	TN
Zip	:	37068-1478
Country	:	US
Telephone Number	:	615-591-6590
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 N CASTLE HEIGHTS AVE STE G
Second Line	:
City	:	LEBANON
State	:	TN
Zip	:	37087-1512
Country	:	US
Telephone Number	:	615-443-4938
Fax Number	:

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

Provider Enumeration Date	:	09/12/2018
Last Update Date	:	02/11/2019

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Directions to “ BROOKE MCCALL ” Practice Location

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