Healthcare Provider Details

I. General information

NPI: 1083520647
Provider Name (Legal Business Name): BROCK WESTON MILLER SIMMONS DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5944 STEUBENVILLE PIKE STE F
MC KEES ROCKS PA
15136-1315
US

IV. Provider business mailing address

137 DANA DR
SEWICKLEY PA
15143-8395
US

V. Phone/Fax

Practice location:
  • Phone: 412-788-6630
  • Fax: 412-788-6632
Mailing address:
  • Phone: 573-625-1003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT034571
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: