Provider Demographics
NPI:1912220757
Name:ROCKLEIN, BRADLEY ROBERT (PT)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:ROBERT
Last Name:ROCKLEIN
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 1:163 DELAWARE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1313
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:163 DELAWARE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1313
Practice Address - Country:US
Practice Address - Phone:518-928-8103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016247-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist