Individual
LUCY ROSE BROCKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
N4223 KILLARNEY LN, FREEDOM, WI 54130-7168
(920) 740-1471
Mailing address
N4223 KILLARNEY LANE, FREEDOM, WI 54130-7168
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1778-019
WI
Other
Enumeration date
10/01/2012
Last updated
10/01/2012
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