Provider Demographics
NPI:1225706153
Name:IRELAND, BROOKE ROSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:ROSE
Last Name:IRELAND
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ROSE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10940 FAIRFAX BLVD STE D1
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4301
Practice Address - Country:US
Practice Address - Phone:571-321-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022009472225100000X
OR65060225100000X
TN14695225100000X
OR225100000X
TX1347568225100000X
HIPT-5284225100000X
VACP043999T225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist