Provider Demographics
NPI:1366922304
Name:MOCKLER, JACQUELINE (DPT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:MOCKLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 PHILLIPS DR
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763-1958
Mailing Address - Country:US
Mailing Address - Phone:631-793-7094
Mailing Address - Fax:
Practice Address - Street 1:2100 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-3577
Practice Address - Country:US
Practice Address - Phone:631-580-2526
Practice Address - Fax:631-580-2530
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP12595225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist