MEDICARE: MRS. BROOKE SMITH

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	374J00000X	Doula	19783	PA
2	374J00000X	Doula	2295	DE
3	225700000X	Massage Therapist	MSG014494	PA

General Provider Information

NPI Number	:	1801677190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BROOKE SMITH

Provider Business Mailing Address
First Line	:	1517 E BARRINGER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-3301
Country	:	US
Telephone Number	:	267-688-4793
Fax Number	:

Provider Business Practice Location Address
First Line	:	1517 E BARRINGER ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19150-3301
Country	:	US
Telephone Number	:	267-688-4793
Fax Number	:

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

Provider Enumeration Date	:	10/11/2023
Last Update Date	:	11/20/2024

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Directions to “ MRS. BROOKE SMITH ” Practice Location

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