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General NPI Number Information
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NPI Number | 1962353896
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Entity Type | Individual
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Provider Name | JESSICA LEANNE BROCK DPT
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Gender | Female
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Dates
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Enumeration Date | 02/06/2026
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 1035 RED BUD RD NE
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City | CALHOUN
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State | GA
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Zip | 30701-6010
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Country | US
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Telephone | 706-602-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 3811 CHERWOOD LN APT A
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City | CHATTANOOGA
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State | TN
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Zip | 37406-1211
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Country | US
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Telephone | 706-506-8727
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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 | PT015558
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License Number State | GA
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