Healthcare Provider Details

I. General information

NPI: 1194685057
Provider Name (Legal Business Name): TREY BROCK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 TULIP CT
BRUNSWICK OH
44212-3122
US

IV. Provider business mailing address

7787 HUB PARKWAY
VALLEY VIEW OH
44125
US

V. Phone/Fax

Practice location:
  • Phone: 330-524-6454
  • Fax:
Mailing address:
  • Phone: 330-524-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberC.2506662-TRNE
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: