Provider Demographics
NPI:1467594168
Name:ALCOCK, JOHN (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:ALCOCK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W BRUCE ST STE B
Mailing Address - Street 2:PO BOX 1192
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2319
Mailing Address - Country:US
Mailing Address - Phone:812-522-7887
Mailing Address - Fax:812-522-7326
Practice Address - Street 1:2475 N PARK DR STE 20
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-2215
Practice Address - Country:US
Practice Address - Phone:812-372-7800
Practice Address - Fax:812-372-0706
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05000239A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000175780OtherINDIVIDUAL BCBS NUMBER
IN000000175780OtherINDIVIDUAL BCBS NUMBER