Provider Demographics
NPI:1447293907
Name:BROOKS, HEATHER D (PT)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:D
Last Name:BROOKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:D
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:405 E MARSHALL ST
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75644-2331
Mailing Address - Country:US
Mailing Address - Phone:903-402-1052
Mailing Address - Fax:888-335-2090
Practice Address - Street 1:405 E MARSHALL ST
Practice Address - Street 2:
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644-2331
Practice Address - Country:US
Practice Address - Phone:903-402-1052
Practice Address - Fax:888-335-2090
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPT 1145621225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1145621OtherPT #