Provider Demographics
NPI:1306259767
Name:BROOKS, KOEL JOSEPH (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:KOEL
Middle Name:JOSEPH
Last Name:BROOKS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 WINDING HILL RD
Mailing Address - Street 2:302
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1365
Mailing Address - Country:US
Mailing Address - Phone:815-291-5671
Mailing Address - Fax:
Practice Address - Street 1:1820 W 3RD ST
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52802-1812
Practice Address - Country:US
Practice Address - Phone:563-327-0135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA072983225100000X
IL070.020186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist