Provider Demographics
NPI:1225706153
Name:IRELAND, BROOKE ROSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ROSE
Last Name:IRELAND
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ROSE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:1424 MOLALLA AVE
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-4004
Practice Address - Country:US
Practice Address - Phone:503-744-4916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2024-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022009472225100000X
OR65060225100000X
TN14695225100000X
OR225100000X
TX1347568225100000X
HIPT-5284225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist