Brooke Tedder

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2090815 Issued in TX

Practice address

758 Saint Anne St
Clute, TX 77531-3729

Phone

(979) 241-8287

NPI assigned

Jan 14, 2015

Last updated

Jan 14, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1421193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421193600000",
    "number": "1740679760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "758 SAINT ANNE ST",
            "city": "CLUTE",
            "state": "TX",
            "postal_code": "775313729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "758 SAINT ANNE ST",
            "city": "CLUTE",
            "state": "TX",
            "postal_code": "775313729",
            "telephone_number": "979-241-8287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TEDDER",
        "first_name": "BROOKE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-01-14",
        "last_updated": "2015-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2090815",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapy Assistant in Clute, TX
• Providers in Clute, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.