Provider Demographics
NPI:1083836092
Name:BOCKHOP, JAMIE L (PT/LAT)
Entity Type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:L
Last Name:BOCKHOP
Suffix:
Gender:M
Credentials:PT/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913
Mailing Address - Country:US
Mailing Address - Phone:608-356-2334
Mailing Address - Fax:608-356-2636
Practice Address - Street 1:626 14TH STREET
Practice Address - Street 2:SUITE 2
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913
Practice Address - Country:US
Practice Address - Phone:608-356-2334
Practice Address - Fax:608-356-2636
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10782-024225100000X
WI10782-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist