Provider Demographics
NPI:1306429253
Name:STEVENS, BROOKE MAY (DPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:MAY
Last Name:STEVENS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5840 BANNEKER RD STE 230
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3116
Mailing Address - Country:US
Mailing Address - Phone:410-884-0003
Mailing Address - Fax:410-884-0002
Practice Address - Street 1:5840 BANNEKER RD STE 230
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3116
Practice Address - Country:US
Practice Address - Phone:410-884-0003
Practice Address - Fax:410-884-0002
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28272225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist