Provider Demographics
NPI:1184054595
Name:ROCK, NICHOLAS
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:ROCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64541 VAN DYKE RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:WASHINGTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48095-2570
Mailing Address - Country:US
Mailing Address - Phone:586-935-1100
Mailing Address - Fax:586-935-1101
Practice Address - Street 1:33900 HARPER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48035-4258
Practice Address - Country:US
Practice Address - Phone:586-416-9100
Practice Address - Fax:586-416-9103
Is Sole Proprietor?:No
Enumeration Date:2013-11-21
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist