Provider Demographics
NPI:1467775106
Name:FROCK, ANDREA H (MS, PT)
Entity Type:Individual
Prefix:MS
First Name:ANDREA
Middle Name:H
Last Name:FROCK
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 BROOKRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3429
Mailing Address - Country:US
Mailing Address - Phone:443-465-1941
Mailing Address - Fax:410-252-1976
Practice Address - Street 1:104 BROOKRIDGE CT
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-3429
Practice Address - Country:US
Practice Address - Phone:443-465-1941
Practice Address - Fax:410-252-1976
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD17207OtherPHYSICAL THERAPY LICENSE