Individual
SHANA BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4276
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
182550
—
OR
01
—
331581
PROVIDENCE
—
01
—
5512826
FIRST HEALTH
—
01
—
804449004
BLUE CROSS/BLUE SHIELD
OR
01
—
H254805
PACIFIC SOURCE
OR
Enumeration date
11/15/2005
Last updated
09/28/2022
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