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General NPI Number Information
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NPI Number | 1336021708
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Entity Type | Individual
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Provider Name | LILY BROCK PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 07/24/2025
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Last Update Date | 10/21/2025
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Provider Practice Location Address
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Address Line | 7300 WASHINGTON AVE STE B
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City | MOUNT PLEASANT
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State | WI
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Zip | 53406-6525
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Country | US
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Telephone | 262-321-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 2352 N 85TH ST
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City | WAUWATOSA
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State | WI
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Zip | 53226-1910
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Country | US
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Telephone | 414-477-5977
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 17336-24
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License Number State | WI
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