Provider Demographics
NPI:1235878984
Name:SULLIVAN, BROOKE FRANCIS
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:FRANCIS
Last Name:SULLIVAN
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 1:3557 RAMSAY ST APT 2A
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9024
Mailing Address - Country:US
Mailing Address - Phone:713-569-1677
Mailing Address - Fax:
Practice Address - Street 1:6905 KNIGHTDALE BLVD STE 102
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6506
Practice Address - Country:US
Practice Address - Phone:919-373-8086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP21470225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist