Provider Demographics
NPI:1215176243
Name:MENGWASSER, BROOKE MICHAEL (PT)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:MICHAEL
Last Name:MENGWASSER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:MICHAEL
Other - Last Name:KASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:10150 W NATIONAL AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53227-2145
Mailing Address - Country:US
Mailing Address - Phone:866-458-2337
Mailing Address - Fax:888-873-3992
Practice Address - Street 1:110 BELMONT RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53714-3129
Practice Address - Country:US
Practice Address - Phone:608-249-7391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-15
Last Update Date:2009-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5405024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist