Provider Demographics
NPI:1154128593
Name:DELANOY, BROOKE (PTA)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:DELANOY
Suffix:
Gender:
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 WESTBROOK DR APT 422
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-2030
Mailing Address - Country:US
Mailing Address - Phone:260-418-5123
Mailing Address - Fax:
Practice Address - Street 1:4180 SAGE BLUFF XING
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2363
Practice Address - Country:US
Practice Address - Phone:260-443-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06006365A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant