Provider Demographics
NPI:1467920629
Name:BROCKERT, KATHERINE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BROCKERT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5239 KNOWLTON ST APT B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2027
Mailing Address - Country:US
Mailing Address - Phone:310-593-1496
Mailing Address - Fax:
Practice Address - Street 1:2730 WILSHIRE BLVD STE 533
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4751
Practice Address - Country:US
Practice Address - Phone:310-828-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist