Provider Demographics
NPI:1114040003
Name:BOKELMAN, ROY FREDRICK III (PT)
Entity Type:Individual
Prefix:MR
First Name:ROY
Middle Name:FREDRICK
Last Name:BOKELMAN
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1535 CRESTWOOD AVE
Mailing Address - Street 2:#1
Mailing Address - City:MANTECA
Mailing Address - State:CA
Mailing Address - Zip Code:95336-2840
Mailing Address - Country:US
Mailing Address - Phone:209-923-0961
Mailing Address - Fax:
Practice Address - Street 1:1212 N CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95202-1552
Practice Address - Country:US
Practice Address - Phone:209-468-8660
Practice Address - Fax:209-468-2084
Is Sole Proprietor?:No
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32628167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician