Provider Demographics
NPI:1114071131
Name:BROCK, MURIEL (PT)
Entity Type:Individual
Prefix:
First Name:MURIEL
Middle Name:
Last Name:BROCK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9108 N STARK CT
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64157-9750
Mailing Address - Country:US
Mailing Address - Phone:816-841-4697
Mailing Address - Fax:
Practice Address - Street 1:11900 W 87TH STREET PKWY
Practice Address - Street 2:SUITE 125
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-2807
Practice Address - Country:US
Practice Address - Phone:913-747-6100
Practice Address - Fax:913-747-6101
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01965225100000X
KS11-01563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist