Provider Demographics
NPI:1720380454
Name:BROCKMAN, TODD M (PT, MS, DPT)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:M
Last Name:BROCKMAN
Suffix:
Gender:M
Credentials:PT, MS, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 OBLIQUE ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1927
Mailing Address - Country:US
Mailing Address - Phone:859-371-1929
Mailing Address - Fax:
Practice Address - Street 1:13 OBLIQUE ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1927
Practice Address - Country:US
Practice Address - Phone:859-371-1929
Practice Address - Fax:859-371-2581
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2011-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0037232251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic