MEDICARE: LAURA ROSE BROCK

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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1730644964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ROSE BROCK

Provider Business Mailing Address
First Line	:	160 E 56TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10022-3609
Country	:	US
Telephone Number	:	212-355-7827
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 ARNOLD PALMER BLVD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40245-3222
Country	:	US
Telephone Number	:	631-220-1581
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2019
Last Update Date	:	02/01/2019

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Directions to “ LAURA ROSE BROCK ” Practice Location

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