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NPI Code Detail

MEDICARE: BROCK LISTER

MEDICARE: BROCK LISTER
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
1225100000XPhysical Therapist31894FL

General Provider Information

NPI Number : 1245612522
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROCK LISTER
Provider Business Mailing Address
First Line : 802 E WHITING ST
Second Line :
City : TAMPA
State : FL
Zip : 33602-4136
Country : US
Telephone Number : 716-523-1783
Fax Number :
Provider Business Practice Location Address
First Line : 802 E WHITING ST
Second Line :
City : TAMPA
State : FL
Zip : 33602-4136
Country : US
Telephone Number : 716-523-1783
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2015
Last Update Date : 03/22/2024

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Directions to “ BROCK LISTER ” Practice Location

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