Provider Demographics
NPI:1427527456
Name:COMER, BROOKE L (DPT, LAT, ATC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:L
Last Name:COMER
Suffix:
Gender:F
Credentials:DPT, LAT, ATC
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:L
Other - Last Name:WITTRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:708 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-2422
Mailing Address - Country:US
Mailing Address - Phone:641-437-1977
Mailing Address - Fax:641-437-1976
Practice Address - Street 1:708 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-2422
Practice Address - Country:US
Practice Address - Phone:641-437-1977
Practice Address - Fax:641-437-1976
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092392225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA092392OtherLICENSE