Provider Demographics
NPI:1437550449
Name:BROCK, JOSEPH CRAIG (LAT)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CRAIG
Last Name:BROCK
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 DURRETT PL
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-7105
Mailing Address - Country:US
Mailing Address - Phone:806-670-0252
Mailing Address - Fax:
Practice Address - Street 1:5700 DURRETT PL
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-7105
Practice Address - Country:US
Practice Address - Phone:806-670-0252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10922255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer