Provider Demographics
NPI:1316722499
Name:BROOKINS, TRICIA D
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:D
Last Name:BROOKINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5704 RUTGERS LN
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-8169
Mailing Address - Country:US
Mailing Address - Phone:937-765-7185
Mailing Address - Fax:
Practice Address - Street 1:2200 HENDERSON RD # LOFT22
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-7327
Practice Address - Country:US
Practice Address - Phone:937-765-7185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.020453225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist