Provider Demographics
NPI:1992452874
Name:DANIEL, BROOKE
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:DANIEL
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 1:13985 COUNTY ROAD 763
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:MO
Mailing Address - Zip Code:63846-7158
Mailing Address - Country:US
Mailing Address - Phone:573-625-3726
Mailing Address - Fax:
Practice Address - Street 1:13985 COUNTY ROAD 763
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MO
Practice Address - Zip Code:63846-7158
Practice Address - Country:US
Practice Address - Phone:573-625-3726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-09
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160373822251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics