Provider Demographics
NPI:1285961037
Name:BROOKS, SANDRA (MPH, LMT)
Entity type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MPH, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19923 JODI DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5005
Mailing Address - Country:US
Mailing Address - Phone:813-774-4475
Mailing Address - Fax:813-435-2001
Practice Address - Street 1:19923 JODI DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-5005
Practice Address - Country:US
Practice Address - Phone:813-774-4475
Practice Address - Fax:813-435-2001
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA-5943225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist