Provider Demographics
NPI:1053697292
Name:BOCKRATH, HEATHER N
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:N
Last Name:BOCKRATH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 MOXIE LN
Mailing Address - Street 2:
Mailing Address - City:DELPHOS
Mailing Address - State:OH
Mailing Address - Zip Code:45833-9182
Mailing Address - Country:US
Mailing Address - Phone:419-692-3405
Mailing Address - Fax:419-692-3401
Practice Address - Street 1:485 MOXIE LN
Practice Address - Street 2:
Practice Address - City:DELPHOS
Practice Address - State:OH
Practice Address - Zip Code:45833-9182
Practice Address - Country:US
Practice Address - Phone:419-692-3405
Practice Address - Fax:419-692-3401
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT.013521225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist