=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083527139
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BROCK ALEXANDER MASON DPT, PT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2026
-----------------------------------------------------
Last Update Date | 09/28/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1045 BEECHER XING N STE C
-----------------------------------------------------
City | GAHANNA
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43230-4573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-775-9618
-----------------------------------------------------
Fax | 614-775-9633
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11945 LITHOPOLIS RD NW
-----------------------------------------------------
City | CANAL WINCHESTER
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43110-9585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-775-9618
-----------------------------------------------------
Fax | 614-775-9633
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | PT022606
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------