Provider Demographics
NPI:1528647625
Name:SHOOK, BRINAE
Entity type:Individual
Prefix:
First Name:BRINAE
Middle Name:
Last Name:SHOOK
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:PO BOX 732
Mailing Address - Street 2:
Mailing Address - City:SUNRAY
Mailing Address - State:TX
Mailing Address - Zip Code:79086-0732
Mailing Address - Country:US
Mailing Address - Phone:806-421-9621
Mailing Address - Fax:
Practice Address - Street 1:36 WORKMAN TER
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-1162
Practice Address - Country:US
Practice Address - Phone:806-429-9621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2143780225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant