Provider Demographics
NPI:1518251404
Name:BOCHETTE, BRIAN LEE (PT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:LEE
Last Name:BOCHETTE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 E BRAMAN CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-6711
Mailing Address - Country:US
Mailing Address - Phone:239-340-3597
Mailing Address - Fax:
Practice Address - Street 1:6314 WHISKEY CREEK DR STE D
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-8762
Practice Address - Country:US
Practice Address - Phone:239-432-0556
Practice Address - Fax:239-432-9727
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT25780261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT25780OtherSTATE OF FLORIDA