Provider Demographics
NPI:1851119242
Name:BROOKS TATE, VALERIE JUNE (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:JUNE
Last Name:BROOKS TATE
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:J
Other - Last Name:BROOKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MASSAGE THERAPIST
Mailing Address - Street 1:8129 HARMONY WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-1302
Mailing Address - Country:US
Mailing Address - Phone:502-299-4256
Mailing Address - Fax:
Practice Address - Street 1:7104 NOVAS LNDG LOT 215
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1899
Practice Address - Country:US
Practice Address - Phone:502-299-4256
Practice Address - Fax:812-203-5678
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT22408461225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist