Basic Information
| Provider Information | |||||||||
| NPI: | 1649998949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TUTWILER | ||||||||
| FirstName: | BROOKE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | LMT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 286 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEW CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109563327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457644774 | ||||||||
| FaxNumber: | 8453628474 | ||||||||
| Practice Location | |||||||||
| Address1: | 286 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NEW CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109563327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457644774 | ||||||||
| FaxNumber: | 8453628474 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2022 | ||||||||
| LastUpdateDate: | 08/22/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | 031831-01 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.