Provider Demographics
NPI:1558969758
Name:BOCKMAN, JERRY JOSEPH
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:JOSEPH
Last Name:BOCKMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11813 MCKELVIE RD
Mailing Address - Street 2:
Mailing Address - City:WEEPING WATER
Mailing Address - State:NE
Mailing Address - Zip Code:68463-2033
Mailing Address - Country:US
Mailing Address - Phone:402-637-4471
Mailing Address - Fax:
Practice Address - Street 1:1268 E HENRY ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:NE
Practice Address - Zip Code:68037-7023
Practice Address - Country:US
Practice Address - Phone:402-234-3333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist