Provider Demographics
NPI:1629288402
Name:DEBROCKY, GLYNN (PT)
Entity Type:Individual
Prefix:
First Name:GLYNN
Middle Name:
Last Name:DEBROCKY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 WAYWAYANDA CT
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3954
Mailing Address - Country:US
Mailing Address - Phone:845-225-2723
Mailing Address - Fax:
Practice Address - Street 1:200 BOCES DR
Practice Address - Street 2:
Practice Address - City:YORKTOWN HTS
Practice Address - State:NY
Practice Address - Zip Code:10598-4321
Practice Address - Country:US
Practice Address - Phone:914-248-2250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003358-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist