Provider Demographics
NPI:1407130891
Name:TROCK, WILLIAM GLENN (CP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:GLENN
Last Name:TROCK
Suffix:
Gender:M
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E KINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28203-4742
Mailing Address - Country:US
Mailing Address - Phone:704-375-2587
Mailing Address - Fax:704-333-4429
Practice Address - Street 1:120 E KINGSTON AVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4742
Practice Address - Country:US
Practice Address - Phone:704-375-2587
Practice Address - Fax:704-333-4429
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCCP0032721744P3200X
1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management