Basic Information
| Provider Information | |||||||||
| NPI: | 1023683919 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRIDGEON | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | ALYSSA | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 HAMLET PL S | ||||||||
| Address2: | |||||||||
| City: | BEL AIR | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210151591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106523917 | ||||||||
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| Practice Location | |||||||||
| Address1: | 700 JOHN RINGLING BLVD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342361542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8443343818 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2021 | ||||||||
| LastUpdateDate: | 05/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | PT37077 | FL | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.