Provider Demographics
NPI:1205302163
Name:BOCK, AMY RENSLO (DPT)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:RENSLO
Last Name:BOCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:AMY
Other - Middle Name:LYNN
Other - Last Name:RENSLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:27251 BRIO CIR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5057
Mailing Address - Country:US
Mailing Address - Phone:425-367-1756
Mailing Address - Fax:
Practice Address - Street 1:27251 BRIO CIR
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-5057
Practice Address - Country:US
Practice Address - Phone:425-367-1756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA295016225100000X
CAPT295016225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty