Provider Demographics
NPI:1740452804
Name:BROCK, MICHAEL K (DPT)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:K
Last Name:BROCK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 E COUNTY LINE RD UNIT M
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-2439
Mailing Address - Country:US
Mailing Address - Phone:303-997-7743
Mailing Address - Fax:303-997-7885
Practice Address - Street 1:2030 E COUNTY LINE RD UNIT M
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80126-2439
Practice Address - Country:US
Practice Address - Phone:303-997-7743
Practice Address - Fax:303-997-7885
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-29
Last Update Date:2011-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO09434356Medicaid