Provider Demographics
NPI:1831505122
Name:BRKOVIC, BOBBI (ATC)
Entity type:Individual
Prefix:
First Name:BOBBI
Middle Name:
Last Name:BRKOVIC
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BROOKWOOD WAY S
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-2702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1007 W WAYNE ST
Practice Address - Street 2:APT 4A
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879-9233
Practice Address - Country:US
Practice Address - Phone:419-512-9903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer