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NPI Code Detail

MEDICARE: MRS. GAIL C BROCK LMT

MEDICARE:  MRS. GAIL C BROCK  LMT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225700000XMassage Therapist3343SC

General Provider Information

NPI Number : 1083850861
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. GAIL C BROCK LMT
Provider Business Mailing Address
First Line : PO BOX 4197
Second Line :
City : GREENVILLE
State : SC
Zip : 29608-4197
Country : US
Telephone Number : 864-616-9918
Fax Number :
Provider Business Practice Location Address
First Line : 112 AIRPORT RD
Second Line :
City : GREENVILLE
State : SC
Zip : 29607-2607
Country : US
Telephone Number : 864-616-9918
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2008
Last Update Date : 12/27/2008

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Directions to “ MRS. GAIL C BROCK LMT” Practice Location

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