Individual
AMY BROOKE FEE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT, OCS, ATC, CSCS
Contact information
Practice address
1448 15TH ST, SUITE 101, SANTA MONICA, CA 90404-2756
(310) 393-1703
(310) 943-0462
Mailing address
1448 15TH ST, SUITE 101, SANTA MONICA, CA 90404-2756
(310) 393-1703
(310) 943-0462
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
27397
CA
2251S0007X
Sports Physical Therapist
27397
CA
2251X0800X
Orthopedic Physical Therapist
Primary
27397
CA
2255A2300X
Athletic Trainer
CERT # 099402403
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7030
PT LICENSE NUMBER
CO
01
—
7521525
AETNA
CA
01
—
W22042
MEDICARE PTAN
CA
01
—
ZZZ08333Z
BLUE SHIELD
CA
Enumeration date
04/17/2007
Last updated
07/15/2013
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