MEDICARE: DR. JOSHUA DANIEL ROOKS PHD

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	103G00000X	Clinical Neuropsychologist	PY10643	FL
2	103TC0700X	Clinical Psychologist	PY10643	FL

General Provider Information

NPI Number	:	1821632779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA DANIEL ROOKS PHD

Provider Business Mailing Address
First Line	:	6520 MIAMI LAKEWAY S
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2747
Country	:	US
Telephone Number	:	616-403-5958
Fax Number	:

Provider Business Practice Location Address
First Line	:	6520 MIAMI LAKEWAY S
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2747
Country	:	US
Telephone Number	:	616-403-5958
Fax Number	:

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

Provider Enumeration Date	:	11/04/2019
Last Update Date	:	11/04/2019

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