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General NPI Number Information
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NPI Number | 1548552557
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Entity Type | Individual
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Provider Name | MARY ROCK ATC, LAT, SA
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Gender | Female
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Dates
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Enumeration Date | 05/09/2011
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 1500 PARK CENTRAL DR STE 401
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City | HIGHLANDS RANCH
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State | CO
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Zip | 80129-6935
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Country | US
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Telephone | 720-916-3802
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Fax | 303-662-9056
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Provider Business Mailing Address
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Address Line | 10796 VALENCIA HILLS ST
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City | LAS VEGAS
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State | NV
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Zip | 89141-4248
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Country | US
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Telephone |
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 0506051
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License Number State | NV
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