Provider Demographics
NPI:1003488511
Name:BRINKMAN, ROXANNE (PTA)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:BRINKMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18727 SUTHERLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SUTHERLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23885-8947
Mailing Address - Country:US
Mailing Address - Phone:804-586-4024
Mailing Address - Fax:
Practice Address - Street 1:3335 S CRATER RD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9214
Practice Address - Country:US
Practice Address - Phone:804-765-6660
Practice Address - Fax:804-765-5412
Is Sole Proprietor?:No
Enumeration Date:2021-07-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001227225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant