Provider Demographics
NPI:1063719987
Name:BROOKS, ROBERT DANA (MPT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANA
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46780 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-8719
Mailing Address - Country:US
Mailing Address - Phone:330-708-1494
Mailing Address - Fax:
Practice Address - Street 1:230 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2508
Practice Address - Country:US
Practice Address - Phone:330-337-8307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.021561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist