Deloris Ann Brockner, RN, LMT
Individual provider Active NPI Massage Therapist · Marianna, FL
NPI 1154094084 · NPPES record last updated Jul 27, 2021
Key facts
- NPI
- 1154094084
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MA90046 (FL)
- Practice address
- 2946 Jefferson St
Marianna, FL 32446-3140 - Phone
- (850) 526-3211
- NPI assigned
- Jul 27, 2021
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA90046 | FL | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Colonics & Massage of Marianna, LLC | Current |
Accepting new patients |
Locations
2946 Jefferson St
Marianna, FL 32446
Phone (850) 526-3211
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MA90046 | FL | Yes |
Addresses
Primary practice location
2946 Jefferson St
Marianna, FL 32446-3140
Mailing address
2946 Jefferson St
Marianna, FL 32446-3140
Phone (850) 526-3211
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8506939625 | Other | FL | NON BILLABLE |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | Laptop | Health Information Exchange (HIE) |
Other providers in Marianna, FL
- Doyle Lon Bosse
- Jessica Bourcier
- Heather Lee Bozeman
- Melissa Smith Braxton
- Breakthru Counseling LLC
- Mary Ellen Broderick
- Brandrail Brown
- Brunner Surgical
- Anna Schack Brunner
- John Garmany Brunner
All providers in Marianna, FL · Massage Therapist in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.