Healthcare Provider Details

I. General information

NPI: 1063336683
Provider Name (Legal Business Name): KRISTIN LEIGH BROCK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 HORSESHOE PIKE
PALMYRA PA
17078-9038
US

IV. Provider business mailing address

PO BOX 494
CAMPBELLTOWN PA
17010-0494
US

V. Phone/Fax

Practice location:
  • Phone: 717-838-2600
  • Fax:
Mailing address:
  • Phone: 717-838-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG013960
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: