Provider Demographics
NPI:1568752749
Name:BROCK, LYNN R (LMT)
Entity Type:Individual
Prefix:MR
First Name:LYNN
Middle Name:R
Last Name:BROCK
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 FM 1092 RD STE 450A
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-2287
Mailing Address - Country:US
Mailing Address - Phone:281-610-8953
Mailing Address - Fax:
Practice Address - Street 1:3334 FM 1092 RD STE 450A
Practice Address - Street 2:
Practice Address - City:MISSOURI CITY
Practice Address - State:TX
Practice Address - Zip Code:77459-2287
Practice Address - Country:US
Practice Address - Phone:281-610-8953
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT7520225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist