Provider Demographics
NPI:1548049547
Name:DIRKS, BROOKE (LAT, ATC)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:
Last Name:DIRKS
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 NW CEDARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-5019
Mailing Address - Country:US
Mailing Address - Phone:515-745-4867
Mailing Address - Fax:
Practice Address - Street 1:655 10TH ST
Practice Address - Street 2:
Practice Address - City:WAUKEE
Practice Address - State:IA
Practice Address - Zip Code:50263-6609
Practice Address - Country:US
Practice Address - Phone:515-745-4867
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA0937862255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer