Active NPI
Gabriel Peterambrose Brooks, PT, MS
- Physical Therapist
- Mesa, AZ
National Provider Identifier
1144206525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- LPT-012504
- Practice address
- 6620 E McKellips Rd Ste 105
Mesa, AZ 85215-2867 - Phone
- (602) 648-5444
- Fax
- (602) 772-3801
- NPI assigned
- Dec 19, 2005
- Last updated
- Jan 18, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | LPT-012504 | AZ | Primary |
Addresses
Primary practice location
6620 E McKellips Rd Ste 105
Mesa, AZ 85215-2867
Mailing address
PO Box 80217
Phoenix, AZ 85060-0217
Phone (602) 385-2115
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 240618 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPT-012504 | AZ | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Affiliates in Physical Therapy, Inc. | Physical Therapist | Past | Accepting new patients |
| Lake Jackson Rehabilitation and Wellness Center | Physical Therapist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Physical Therapist
- Houston, TX
- NPI 1760468482
-
- Physical Therapist
- Lake Jackson, TX
- NPI 1952346264
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674000000000",
"number": "1144206525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 80217",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850600217",
"telephone_number": "602-385-2115",
"fax_number": "480-418-3323"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6620 E MCKELLIPS RD STE 105",
"city": "MESA",
"state": "AZ",
"postal_code": "852152867",
"telephone_number": "602-648-5444",
"fax_number": "602-772-3801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOKS",
"first_name": "GABRIEL",
"middle_name": "PETERAMBROSE",
"name_prefix": "Mr.",
"credential": "PT, MS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-19",
"last_updated": "2023-01-18",
"certification_date": "2023-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AZ",
"license": "LPT-012504",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "240618",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.