Provider Demographics
NPI:1942529094
Name:BROCKMAN, STEPHANIE TRUDEAU (PT)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:TRUDEAU
Last Name:BROCKMAN
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 1:527 RAVEN RDG
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2343
Mailing Address - Country:US
Mailing Address - Phone:512-787-9996
Mailing Address - Fax:
Practice Address - Street 1:527 RAVEN RDG
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2343
Practice Address - Country:US
Practice Address - Phone:512-787-9996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-27
Last Update Date:2012-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11746382251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics