Active NPI
Brooke Deann Lane, PT
- Physical Therapist
- Holland, AR
National Provider Identifier
1871706895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2521
- Practice address
- 14 Hideaway Rd
Holland, AR 72173-9823 - Phone
- (501) 428-0272
- NPI assigned
- May 7, 2007
- Last updated
- Feb 15, 2022
- Sex
- Female
- 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 | 2521 | AR | Primary |
Addresses
Primary practice location
14 Hideaway Rd
Holland, AR 72173-9823
Mailing address
14 Hideaway Rd
Holland, AR 72173-9823
Phone (501) 428-0272
Other names 1
- Brooke Gabbard
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181005002016 | AR | Practitioner - Physical Therapist in Private Practice | 3577815307 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2521 | AR | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178496000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644883200000",
"number": "1871706895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 HIDEAWAY RD",
"city": "HOLLAND",
"state": "AR",
"postal_code": "721739823",
"telephone_number": "501-428-0272"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14 HIDEAWAY RD",
"city": "HOLLAND",
"state": "AR",
"postal_code": "721739823",
"telephone_number": "501-428-0272"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANE",
"first_name": "BROOKE",
"middle_name": "DEANN",
"name_prefix": "Mrs.",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-07",
"last_updated": "2022-02-15",
"certification_date": "2022-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "AR",
"license": "2521",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "BROOKE",
"last_name": "GABBARD",
"code": "1",
"type": "Former Name"
}
]
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.