Provider Demographics
NPI:1285991158
Name:HEATHCOATE - POWERS, BROOK ASHLEY (CMT)
Entity type:Individual
Prefix:MS
First Name:BROOK
Middle Name:ASHLEY
Last Name:HEATHCOATE - POWERS
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 LUCILE AVE STE D
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95209-4703
Mailing Address - Country:US
Mailing Address - Phone:559-381-8645
Mailing Address - Fax:
Practice Address - Street 1:1955 LUCILE AVE STE D
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95209-4703
Practice Address - Country:US
Practice Address - Phone:559-381-8645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-17
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28875175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherPHYSICAL MEDICINE