MEDICARE: MS. RUTH BROOKS 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	PT001932	WV
2	225100000X	Physical Therapist	PT012904L	PA

General Provider Information

NPI Number	:	1831213610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RUTH BROOKS PT

Provider Business Mailing Address
First Line	:	633 W VIRGINIA AVE
Second Line	:
City	:	MORGANTOWN
State	:	WV
Zip	:	26501-6764
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1539 COUNTRY CLUB RD
Second Line	:
City	:	FAIRMONT
State	:	WV
Zip	:	26554-1306
Country	:	US
Telephone Number	:	304-363-8479
Fax Number	:	304-366-9125

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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