Provider Demographics
NPI:1689482382
Name:GAINES, BROOKLYNN (LMT)
Entity type:Individual
Prefix:
First Name:BROOKLYNN
Middle Name:
Last Name:GAINES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 BOAT RAMP RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:KY
Mailing Address - Zip Code:42728-9572
Mailing Address - Country:US
Mailing Address - Phone:270-403-7600
Mailing Address - Fax:
Practice Address - Street 1:121 S PUBLIC SQ
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:KY
Practice Address - Zip Code:42743-1532
Practice Address - Country:US
Practice Address - Phone:270-403-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY289263225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist