Provider Demographics
NPI:1508643388
Name:BROCK-JONES, KORLEEN
Entity Type:Individual
Prefix:
First Name:KORLEEN
Middle Name:
Last Name:BROCK-JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 N NOTTING HILL LN
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-0504
Mailing Address - Country:US
Mailing Address - Phone:559-797-6635
Mailing Address - Fax:
Practice Address - Street 1:221 W FIR AVE STE 105
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-0223
Practice Address - Country:US
Practice Address - Phone:559-325-3444
Practice Address - Fax:559-325-7444
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304876225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist