Provider Demographics
NPI:1548276314
Name:BROOKS, THOMAS P (MS PT ATC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:BROOKS
Suffix:
Gender:M
Credentials:MS PT ATC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:4000 S EASTERN AVE
Practice Address - Street 2:300
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-0824
Practice Address - Country:US
Practice Address - Phone:702-734-2732
Practice Address - Fax:702-737-1453
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0079225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1548276314Medicaid
V105812OtherMEDICARE PTAN