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Individual

JORDAN ROBERT BROCKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DPT

Contact information

Practice address
15410 S MOUNTAIN PKWY, #112, PHOENIX, AZ 85044-6691
(480) 706-1161
(480) 706-7409
Mailing address
4715 N 32ND ST, #108, PHOENIX, AZ 85018-3300
(480) 689-5520
(480) 706-7409

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
10308
AZ
2251S0007X
Sports Physical Therapist
2251X0800X
Orthopedic Physical Therapist

Other

Enumeration date
06/17/2013
Last updated
08/08/2013
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