Provider Demographics
NPI:1376864074
Name:BROKERING, DOROTHY D (DPT)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:D
Last Name:BROKERING
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:D
Other - Last Name:MATTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8055 O ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2564
Mailing Address - Country:US
Mailing Address - Phone:402-421-0904
Mailing Address - Fax:
Practice Address - Street 1:575 S 70TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2471
Practice Address - Country:US
Practice Address - Phone:402-219-7495
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098147080Medicare PIN