Provider Demographics
NPI:1386608206
Name:BROOKS, DEBRA ANN (PT)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:ANN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4180 PRAIRIE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55123-1626
Mailing Address - Country:US
Mailing Address - Phone:651-456-9601
Mailing Address - Fax:
Practice Address - Street 1:6515 BARRIE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2305
Practice Address - Country:US
Practice Address - Phone:952-922-5019
Practice Address - Fax:952-922-1384
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2337225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist