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Individual

SHANE BROOKS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
TRS, CTRS

Contact information

Practice address
5500 W BAGLEY PARK RD, WEST JORDAN, UT 84081-5697
(801) 282-1000
Mailing address
5500 W BAGLEY PARK RD, WEST JORDAN, UT 84081-5697
(801) 282-1000

Taxonomy

Speciality
Code
Description
License number
State
226000000X
Recreational Therapist Assistant
Primary
12998539-4002
UT

Other

Enumeration date
09/24/2024
Last updated
09/24/2024
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