Provider Demographics
NPI:1982938437
Name:BROCKIE, AGATHA D (PT)
Entity Type:Individual
Prefix:
First Name:AGATHA
Middle Name:D
Last Name:BROCKIE
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 1:212 WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2337
Mailing Address - Country:US
Mailing Address - Phone:859-625-0564
Mailing Address - Fax:859-625-1109
Practice Address - Street 1:212 WAYNE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2337
Practice Address - Country:US
Practice Address - Phone:859-625-0564
Practice Address - Fax:859-625-1109
Is Sole Proprietor?:No
Enumeration Date:2009-09-30
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY005510225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist