Provider Demographics
NPI:1447522339
Name:BOCKENSTEDT, TROY (DPT)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:BOCKENSTEDT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 53
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-0053
Mailing Address - Country:US
Mailing Address - Phone:319-930-2868
Mailing Address - Fax:319-626-2669
Practice Address - Street 1:1295 JORDAN ST STE 3
Practice Address - Street 2:
Practice Address - City:NORTH LIBERTY
Practice Address - State:IA
Practice Address - Zip Code:52317-8078
Practice Address - Country:US
Practice Address - Phone:319-930-2868
Practice Address - Fax:319-626-2669
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA004885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1212Medicare PIN
IAIB1212027Medicare PIN
IAIB1213027Medicare PIN
IAIB1213Medicare PIN