Provider Demographics
NPI:1962786889
Name:BROOKS, JENEL (LMT)
Entity type:Individual
Prefix:MRS
First Name:JENEL
Middle Name:
Last Name:BROOKS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 RUSSELLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42261-7511
Mailing Address - Country:US
Mailing Address - Phone:270-999-0163
Mailing Address - Fax:
Practice Address - Street 1:725 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:MORGANTOWN
Practice Address - State:KY
Practice Address - Zip Code:42261-9431
Practice Address - Country:US
Practice Address - Phone:270-526-6206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-1955225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist