Basic Information
| Provider Information | |||||||||
| NPI: | 1235852658 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MERRILL | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | ALEXANDRA | ||||||||
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| Credential: | PT, DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9075 GAYLORD DR APT 53 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770242955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7579690775 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 209 E ROGERS BLVD | ||||||||
| Address2: | |||||||||
| City: | SKIATOOK | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740701251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9183969799 | ||||||||
| FaxNumber: | 9183969891 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2022 | ||||||||
| LastUpdateDate: | 09/23/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1368776 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.