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NPI Code Detail

MEDICARE: MRS. MICHELLE LYNN BROCK M.P.T.

MEDICARE: MRS. MICHELLE LYNN BROCK M.P.T.
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
12251X0800XOrthopedic Physical Therapist5501005109MI

General Provider Information

NPI Number : 1801923479
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MICHELLE LYNN BROCK M.P.T.
Provider Business Mailing Address
First Line : 39831 SYLVIA ST
Second Line :
City : HARRISON TOWNSHIP
State : MI
Zip : 48045-1541
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 20952 E 12 MILE RD STE 110
Second Line :
City : SAINT CLAIR SHORES
State : MI
Zip : 48081-3202
Country : US
Telephone Number : 586-498-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2007
Last Update Date : 07/08/2007

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Directions to “ MRS. MICHELLE LYNN BROCK M.P.T.” Practice Location

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