Provider Demographics
NPI:1427252998
Name:BROOKS, CHRISTY LYN (MPT)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LYN
Last Name:BROOKS
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GILLAND CT
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-2901
Mailing Address - Country:US
Mailing Address - Phone:410-421-5160
Mailing Address - Fax:
Practice Address - Street 1:1406B CRAIN HWY S
Practice Address - Street 2:SUITE 107
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4099
Practice Address - Country:US
Practice Address - Phone:410-590-2334
Practice Address - Fax:410-590-2336
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD008NQ966Medicare PIN