Provider Demographics
NPI:1487337556
Name:RICHARDSON, BROOKE LANE (DPT)
Entity type:Individual
Prefix:
First Name:BROOKE
Middle Name:LANE
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:ELIZABETH
Other - Last Name:LANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1600 LONG GROVE DR UNIT 925
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7450
Mailing Address - Country:US
Mailing Address - Phone:843-446-5004
Mailing Address - Fax:
Practice Address - Street 1:8536 PALMETTO COMMERCE PKWY # 207A
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-6700
Practice Address - Country:US
Practice Address - Phone:843-402-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT.11998225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist