Individual
MR. BRYAN JAMES BROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
5546 S FORT APACHE RD STE 200, LAS VEGAS, NV 89148-7692
(702) 947-9994
(702) 947-9998
Mailing address
325 HANSON ST, WINNEMUCCA, NV 89445-3607
(775) 625-2222
(775) 625-1131
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1590
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100503507
—
NV
01
—
NV1590
BCBS
NV
Enumeration date
08/18/2005
Last updated
04/18/2014
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