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Individual

SANCIA RENEE BROOKS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
212 MIDDLE DAYLE DR, PORTLAND, TN 37148-2060
(615) 719-4347
Mailing address
212 MIDDLE DAYLE DR, PORTLAND, TN 37148-2060
(615) 719-4347

Taxonomy

Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
207921
TN
332BC3200X
Customized Equipment (DME)
Primary
207921
TN
335E00000X
Prosthetic/Orthotic Supplier
207921
TN

Other

Enumeration date
07/18/2024
Last updated
07/18/2024
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