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NPI Code Detail

MEDICARE: DANIEL BROCKEVELT

MEDICARE: DANIEL BROCKEVELT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant1412NE

General Provider Information

NPI Number : 1952851420
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIEL BROCKEVELT
Provider Business Mailing Address
First Line : 6226 S 194TH AVE
Second Line :
City : OMAHA
State : NE
Zip : 68135-3723
Country : US
Telephone Number : 402-216-9478
Fax Number :
Provider Business Practice Location Address
First Line : 410 W 5TH ST
Second Line :
City : LOUISVILLE
State : NE
Zip : 68037-6006
Country : US
Telephone Number : 402-234-2125
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2016
Last Update Date : 10/09/2016

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Directions to “ DANIEL BROCKEVELT ” Practice Location

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