Provider Demographics
NPI:1063991909
Name:JONES, BROOKE M (DPT)
Entity type:Individual
Prefix:MRS
First Name:BROOKE
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MISS
Other - First Name:BROOKE
Other - Middle Name:M
Other - Last Name:MANGOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:146 N TORNADO WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-6006
Mailing Address - Country:US
Mailing Address - Phone:304-788-7816
Mailing Address - Fax:304-788-7863
Practice Address - Street 1:146 N TORNADO WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-6006
Practice Address - Country:US
Practice Address - Phone:304-788-7816
Practice Address - Fax:304-788-7863
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV004017225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist