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Individual
CHARLES EDMAN BROCKMAN
Active
Individual
CHARLES EDMAN BROCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
1653
MT
225100000X
Physical Therapist
Primary
3101
OR
225100000X
Physical Therapist
912
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
181409
—
OR
01
—
P00952506
RR MEDICARE
OR
Enumeration date
12/16/2005
Last updated
11/01/2012
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