Provider Demographics
NPI:1699184606
Name:BROCK, DENISE M (PTA)
Entity Type:Individual
Prefix:MS
First Name:DENISE
Middle Name:M
Last Name:BROCK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WHITE OAK DR
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-4136
Mailing Address - Country:US
Mailing Address - Phone:440-366-8314
Mailing Address - Fax:
Practice Address - Street 1:18969 N 83RD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2844
Practice Address - Country:US
Practice Address - Phone:888-266-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2014-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10565A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist