Provider Demographics
NPI:1699111583
Name:WARGA, BROOKE LEIGH (DPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LEIGH
Last Name:WARGA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 FARSON STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELPRE
Mailing Address - State:OH
Mailing Address - Zip Code:45714-1067
Mailing Address - Country:US
Mailing Address - Phone:740-423-1507
Mailing Address - Fax:740-401-0660
Practice Address - Street 1:809 FARSON STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1067
Practice Address - Country:US
Practice Address - Phone:740-423-1507
Practice Address - Fax:740-401-0660
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT014197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty