MEDICARE: ALISON BROCK PT

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	PT011849	GA
2	225100000X	Physical Therapist	2305209287	VA

General Provider Information

NPI Number	:	1992198725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON BROCK PT

Provider Business Mailing Address
First Line	:	3118 LENOX PARK CIR NE
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-5358
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3118 LENOX PARK CIR NE
Second Line	:
City	:	BROOKHAVEN
State	:	GA
Zip	:	30319-5358
Country	:	US
Telephone Number	:	757-288-0335
Fax Number	:

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

Provider Enumeration Date	:	03/18/2015
Last Update Date	:	03/18/2015

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Directions to “ ALISON BROCK PT” Practice Location

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