Basic Information
| Provider Information | |||||||||
| NPI: | 1003532466 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RING | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1110 E STATE HIGHWAY 114 STE 100 | ||||||||
| Address2: | |||||||||
| City: | SOUTHLAKE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760925251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177569892 | ||||||||
| FaxNumber: | 8175027412 | ||||||||
| Practice Location | |||||||||
| Address1: | 9525 N BEACH ST STE 413 | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762446438 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8177569892 | ||||||||
| FaxNumber: | 8175027412 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2022 | ||||||||
| LastUpdateDate: | 10/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 2147668 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.