Healthcare Provider Details

I. General information

NPI: 1104738947
Provider Name (Legal Business Name): BRIGITT MOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BROADALBIN ST SW STE 265
ALBANY OR
97321-2296
US

IV. Provider business mailing address

2000 SANTIAM HWY SE
ALBANY OR
97322-4929
US

V. Phone/Fax

Practice location:
  • Phone: 541-801-3644
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number29784
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: