Provider Demographics
NPI:1043052764
Name:SMITH, BROOKE MCKINLEY (DPT)
Entity type:Individual
Prefix:DR
First Name:BROOKE
Middle Name:MCKINLEY
Last Name:SMITH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 O CONNOR CT
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-3740
Mailing Address - Country:US
Mailing Address - Phone:214-755-5545
Mailing Address - Fax:
Practice Address - Street 1:10233 E NORTHWEST HWY STE 410
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75238-4430
Practice Address - Country:US
Practice Address - Phone:469-221-9203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-12
Last Update Date:2024-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3133396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist