Individual
DANIEL BROCKEVELT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
410 W 5TH ST, LOUISVILLE, NE 68037-6006
(402) 234-2125
Mailing address
6226 S 194TH AVE, OMAHA, NE 68135-3723
(402) 216-9478
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1412
NE
Other
Enumeration date
10/09/2016
Last updated
10/09/2016
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