Provider Demographics
NPI:1124040423
Name:BROCK, DAVID F (MSPT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:F
Last Name:BROCK
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:26617 CARMEL CENTER PL
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8655
Mailing Address - Country:US
Mailing Address - Phone:831-622-0599
Mailing Address - Fax:831-622-7599
Practice Address - Street 1:26617 CARMEL CENTER PL
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8655
Practice Address - Country:US
Practice Address - Phone:831-622-0599
Practice Address - Fax:831-622-7599
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 17213225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT172130Medicare ID - Type Unspecified