Provider Demographics
NPI:1740774959
Name:BROKMEIER, ZACHARY GREGORY (LMT)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:GREGORY
Last Name:BROKMEIER
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8119 BEARBERRY ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99502-4348
Mailing Address - Country:US
Mailing Address - Phone:480-329-3825
Mailing Address - Fax:
Practice Address - Street 1:4000 W DIMOND BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99502-1475
Practice Address - Country:US
Practice Address - Phone:907-243-0660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK132994225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist