Provider Demographics
NPI:1356388896
Name:HOCKETT, KATHLEEN JOANN (PT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:JOANN
Last Name:HOCKETT
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 1:505 RIDGE RD N
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0357
Mailing Address - Country:US
Mailing Address - Phone:712-256-4995
Mailing Address - Fax:
Practice Address - Street 1:2085 N 120TH ST
Practice Address - Street 2:SUITE D8
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3479
Practice Address - Country:US
Practice Address - Phone:402-445-4335
Practice Address - Fax:402-445-6162
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1031225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025222400Medicaid
NER30206Medicare UPIN
NE278682Medicare PIN