Healthcare Provider Details

I. General information

NPI: 1225407356
Provider Name (Legal Business Name): DEBORAH D BROCK DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2015
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 JIM BERRY RD
FRANKLIN NC
28734-8660
US

IV. Provider business mailing address

235 JIM BERRY RD
FRANKLIN NC
28734-8660
US

V. Phone/Fax

Practice location:
  • Phone: 828-369-7878
  • Fax: 828-369-8760
Mailing address:
  • Phone: 828-369-7878
  • Fax: 828-369-8760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number15726
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: